[Laparoastoma (open packing) in the treatment concept of infected pancreatic necroses].
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%.
Waclawiczek
H W
HW
I. Chirurgische Abteilung, Landeskrankenanstalten Salzburg.
Chmelizek
F
F
Heinerman
M
M
Pimpl
W
W
Kaindl
H
H
Sungler
P
P
Boeckl
O
O
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
Das Laparoastoma (Open Packing) im Behandlungskonzept infizierter Pankreasnekrosen.