As a result of the conducted clinical and experimental researches new directions for solving of the problem of improvement of acute necrotizing pancreatitis treatment were developed by the introduction of step-up surgical tactics based on the consistent application of the developed minimal invasive interventions, established precise indications to the specific stages of surgical treatment, taking into account the presence and probability of development of organ failure, disorders of the intestinal barrier function, risk and early diagnosis of infected complications and applying of the proposed complex of conservative measures. Since disorders of the intestinal barrier function and activity of the immune response are important events in the pathogenesis of the acute necrotizing pancreatitis we have investigated changes in the content of endotoxin of gram-negative bacteria (lipopolysaccharide) and its soluble receptors sCD14 in the blood plasma. It was found that the contents of sCD14 receptors above 1670 ng/ml at admission had been served as an independent prognostic criteria for the development of purulent-septic complications of examined patients (sensitivity – 87 %, specificity – 81 %). The citrulline level below 12,5 μmol/l allowed the diagnosis of intestinal failure with a sensitivity of 90,4 % and a specificity of 84,6 % (AUC 0,905±0,0179, p=0,001). It has been established by logistic regression that respiratory, cardiovascular, renal and intestinal failures acted as independent factors of the mortality of patients with acute necrotizing pancreatitis.Early stratification of patients in accordance with developed and improved prognostic and diagnostic criteria of the complications occurrence, application of appropriate intensive care measurements, antibiotic prophylaxis and therapy, proposed algorithms of enteral nutrition and treatment of disorders of the intestinal barrier function, an individualized approach for surgery with sequential step-up use of the developed transcutaneous, endo-ultrasaound guided video-endoscopic and combined miniinvasive interventions, low-traumatic selective mini-laparotomies and mini-lumbotomies, performing of laparotomic necrosectomies according to the established indications have allowed to improve the results of surgical treatment of patients with acute necrotizing pancreatitis. The number of "wide" laparotomies was reduced from 76,15 % in the comparison group to 15,87 % (p<0,05) in patients of the main group; the complications were reduced by 2,26 times (p<0,05); postoperative mortality was 3,53 % versus 18,28 % (p<0,05) in the comparison group.
