Objective: The objective of our investigation was to map the approach to the diagnosis and conservative and surgical treatment of acute pancreatitis (AP) at four Prague surgical departments, to evaluate the influence of applied methods on the morbidity and mortality of patients and to analyze thus possible negative prognostic factors. Methods: We analyzed retrospectively the case-records of patients hospitalized at four Prague surgical departments with the diagnosis of AP during the period between Jan. 1, 1992 and Dec. 31, 1996. Results: The investigation comprised a total of 560 patients. The most frequent etiology was biliary (b – 224),followed by idiopathic (i – 250), alcoholic (a – 51) and others (j – 35). The mean period of hospitalization was 16.6 days. Endoscopic retrograde cholangiopancreatography (ERCP) was performed in a total of 104 patients: of 224 patients with biliary AP in 74, and in AP with another etiology than biliary in 30. Early ERCP (within 72 hours after admission) was made in 32 patients. Of 104 and 58 patients resp. treated by ERCP without and with endoscopic papillosphincterotomy (EPT) 9 died, i.e. 8.7%, resp. 2, i.e. 3.5%. Infectious complications developed in 71 patients, i.e. 12.7%, sepsis being most frequent (30). Antibiotics (ATB) were administered to 502 patients from the total number, whereby mainly imidazole and penicillin ATB were used, followed by aminoglycosides and cephalosporins of the I st and II nd generation. A total of 92 patients were operated incl. 30 on the pancreas. In these two groups 34 (37%) and 19 (63.3%) resp. died. Surgery was implemented in the majority during the first three weeks at hospital. A total of 50 patients died, the most frequent cause of death being sepsis (23). Death occurred on average on the 23.2 day in hospital. The mortality of patients referred from another department was higher than of those admitted primarily. Conclusion: From the results of the retrospective study ensues that 1. early ERCP was indicated inadequately, 2. the mortality after EPT was lower than in other patients with biliary AP, 3. patients were operated mainly during the first three weeks in hospital with a high mortality, 4. ATB were administered indiscriminately without due regard to the effectiveness against the assumed pathogenic organisms, 5. the most frequent cause of death was sepsis, 6. the prognosis was poorer in patients referred from other departments.

        Key words: acute pancreatitis – endoscopic retrograde cholangiopancreatography – antibiotics – surgery – referred patients