title: Improved survival in acute necrotizing pancreatitis despite limiting the indications for surgical debridement.
abstract: OBJECTIVE
  To reassess our criteria for the stratification of attacks of acute pancreatitis, and indications for operation in patients with necrotising pancreatitis.
  
  
  METHODS
  Retrospective analysis of casenotes.
  
  
  METHODS
  University Hospital, Germany.
  
  
  METHODS
  341 Consecutive patients who presented with a first attack of acute pancreatitis between December 1979 and January 1991.
  
  
  METHODS
  Morbidity and mortality in relation to clinical (Ranson, Kümmerle, Goris) and radiological (Balthazar) criteria.
  
  
  RESULTS
  78 Patients developed necrotising pancreatitis judged radiologically. Mortality was 15/38 (39%) in the period 1980-85 and 6/40 (15%) in the period 1986-1990. During the first period patients were operated on if their unfavourable clinical signs did not start to resolve within 72 hours, whereas in the second period operation was restricted to those patients who developed signs of multiple organ failure. This policy resulted in the number of operations being reduced from 26/38 (68%) to 17/40 (42%), respectively (p = 0.03).
  
  
  CONCLUSIONS
  Our data support the policy of restricting surgical debridement in necrotising pancreatitis to those patients who develop signs of multiple organ failure.
authors.affiliation: Department of Surgery, University of Heidelberg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Foitzik
authors.forename: E
authors.initials: E
authors.lastname: Klar
authors.forename: H J
authors.initials: HJ
authors.lastname: Buhr
authors.forename: C
authors.initials: C
authors.lastname: Herfarth
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000209:etiology; D003646:Debridement; D005858:Germany / Q000453:epidemiology; D006801:Humans; D009102:Multiple Organ Failure / Q000209:etiology / Q000601:surgery; D009336:Necrosis; D010195:Pancreatitis / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D011859:Radiography; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D018805:Sepsis / Q000382:microbiology; D015996:Survival Rate