title: [Laparoastoma (open packing) in the treatment concept of infected pancreatic necroses].
abstract: Out of 284 patients with acute pancreatitis 73 (26%) had pancreas necrosis. Of these 73 cases 43 patients with infected pancreas necrosis were treated surgically, whereas conservative treatment proved successful in the remaining 30 cases with so-called sterile necrosis. Our interdisciplinary treatment combined delayed surgery for the better demarcation of the necrotic tissue, with extended intensive care therapy and epigastral laparostomy; through this laparostomy surgical revision with necrosectomy and peritoneal lavage was performed daily for 15 (+/- 6) days, necessitating long-term artificial respiration for an average of 15 (4/168) days. The mortality rate in the 43 patients with infected pancreas necrosis amounted to 16.2% (n = 7); none of the patients with sterile necrosis died. In cases of multiple organ failure the mortality rate was significantly higher (30%) than with failure of only one organ system (4.3%). The mortality rate in all cases with pancreas necrosis (n = 73) amounted therefore to 9.5%. Serious complications of laparostomy occurred in 28% (n = 12) of the 43 patients, whereby 8 of these cases were gastrointestinal fistulae, with a fatal outcome in one patient. The overall mortality rate in the total group of 284 patients with acute pancreatitis was 2.8%.
authors.affiliation: I. Chirurgische Abteilung, Landeskrankenanstalten Salzburg.
authors.forename: H W
authors.initials: HW
authors.lastname: Waclawiczek
authors.forename: F
authors.initials: F
authors.lastname: Chmelizek
authors.forename: M
authors.initials: M
authors.lastname: Heinerman
authors.forename: W
authors.initials: W
authors.lastname: Pimpl
authors.forename: H
authors.initials: H
authors.lastname: Kaindl
authors.forename: P
authors.initials: P
authors.lastname: Sungler
authors.forename: O
authors.initials: O
authors.lastname: Boeckl
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D003422:Critical Care / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010179:Pancreas / Q000473:pathology; D010180:Pancreatectomy / Q000379:methods*; D010195:Pancreatitis / Q000473:pathology / Q000601:surgery*; D010348:Patient Care Team; D011183:Postoperative Complications / Q000473:pathology / Q000601:surgery; D012086:Reoperation
vernacular_title: Das Laparoastoma (Open Packing) im Behandlungskonzept infizierter Pankreasnekrosen.