Rezumat Restanåa septicã, factor decisiv în evoluåia pancreatitelor supurate Reintervenåiile programate sau de necesitate pentru asanarea focarelor septice ocupã un loc important în chirurgia supuraåiilor pancreatice. Aproximativ 50% din pacienåii operaåi necesitã una sau mai multe reintervenåii, în scopul debridãrii æi evacuãrii restanåelor necrotico-supurate. Autorii reanalizeazã spaåiul retroperitoneal ca sediu al proceselor necrotico-supurative, accentuând asupra insuficienåei abordãrii retroperitoneului doar prin bursa omentalã. Considerentele anatomice infirmã credinåa conform cãreia abordul bursei omentale ar fi gestul principal de acces retroperitoneal. Pancreasul æi atmosfera înconjurãtoare sunt gazduite în spaåiul pararenal anterior æi posterior. Pentru evitarea restanåelor septice se insistã asupra a 6 cãi de acces în spaåiul pararenal. Aceste cãi de abord sunt dictate în funcåie de topografia necrozelor supurate. Viitorul evolutiv postoperator al pacientului este direct dependent de prezenåa sau absenåa restanåelor dupã prima intervenåie chirurgicalã. Evident restanåele vor fi acolo unde nu a avut loc debridarea æi evacuarea sepsisului - adicã în toate dependinåele spaåiului pararenal. Drenajul larg, multiplu, închis sau deschis, cu sau fãrã lavaj continuu, nu poate corecta omisiunile septice. Debridãrile paråiale æi incomplete nu trebuie sã se bazeze pe corectãrile prin reintervenåii programate. Cuvinte cheie: supuraåie pancreaticã, debridare, retroperitoneal, restante supurative, necroza pancreaticã, pararenal Abstract Scheduled reinterventions, or dictated by necessity in order to drain the septic foci occupy an important place in the surgery of the pancreatic suppurations. Approximately 50% of the operated patients require one or more reinterventions, in order to accomplish the debridement and evacuation of the necrotic-suppurative remnants. The authors reanalyze the retroperitoneal space as a center of the necrotic- suppurative processes, emphasizing over the insufficiency of the approach of the retroperitoneum only through the omental bursa. The anatomical considerations infirm the belief according to which the approach of the omental bursa would be the primary gesture of retroperitoneal access. The pancreas and the surrounding atmosphere are hosted within the anterior an posterior pararenal space. In order to avoid septic remnants it is insisted on six access pathways to the pararenal space. These ways of approach are dictated accord- ing to topography of the suppurated necrosis. Post surgical evolutional future of the patient is directly dependent on the presence or absence of the remnants after the first surgical intervention. Evidently, the remnants will Septic Remnants, A Crucial Factor in the Outcome of Suppurated Pancreatitis F. Popa 1 , M. Brãtucu 2 , P. Radu 2 , C. Iorga 2 , D. Garofil 2 , A. Cuibac 1 , V. Strâmbu 2 1 Department of General Surgery, “St. Pantelimon” Clinical Emergency Hospital, Bucharest, Romania 2 Department of General Surgery, “Carol Davila” Nephrology Clinical Hospital, Bucharest, Romania General Reports Chirurgia (2013) 108: 7-12 No. 1, January - February Copyright© Celsius Corresponding author: Mircea Brãtucu, MD Department of General Surgery “Carol Davila” Nephrology Clinical Hospital Grivitei street, no. 4, sector 1 Bucharest, Romania E-mail: bratucu_mircea@yahoo.com