Open approach in pancreatic and infected pancreatic necrosis: laparostomies and preplanned revisions.
One hundred and two patients with acute necrotizing pancreatitis were treated in accordance with a combined regimen of necrosectomy, open drainage by laparostomies, and repeated re-explorations. The severity of pancreatitis was assessed by the APACHE II score (median 15 on admission). Eighty-seven (85%) patients were classified as having infected pancreatic necrosis and only 15 (15%) as having pancreatic necrosis. Overall, 36 (35%) patients died, most of multiple organ failure. Survival was significantly impaired by bacterial contamination of pancreatic necrosis (p = 0.008), bacteremia (p = 0.0001) and infected bronchial secretions (p = 0.05). The mortality rate was reduced from 53% to 28% by changing the regimen of re-explorations from on demand to regular 48 hour intervals. Despite the fact that open packing was associated with a high frequency of gastrointestinal fistulas (30%), this concept seems to be a successful and recommendable approach in the therapy of pancreatic and infected pancreatic necrosis.
Függer
R
R
Erste Chirurgische Universitätsklinik, University of Vienna, Austria.
Schulz
F
F
Rogy
M
M
Herbst
F
F
Mirza
D
D
Fritsch
A
A
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D009336:Necrosis; D010195:Pancreatitis / Q000601:surgery*; D011183:Postoperative Complications; D012086:Reoperation