title: Changing strategies in the surgical management of acute necrotizing pancreatitis.
abstract: During 1982-90 we changed the surgical treatment of acute necrotizing pancreatitis twice. The operative strategy consisted of early formal resection (n = 13) during 1982-84, early lavational surgery (n = 15) during 1985-87 and late necrosectomy (n = 17) during 1988-90. The mortality rate decreased from 54% to 40% and to 24%, respectively. The pattern of complications changed from bleeding in resections to pseudocysts and fistulas in late necrosectomy. Sepsis and multiorgan failure were still main problems. These results led us to begin a prospective study of planned repeated debridement by open packing after delayed necrosectomy.
authors.affiliation: Department of Surgery, Tampere University Hospital, Finland.
authors.forename: H
authors.initials: H
authors.lastname: Paajanen
authors.forename: M
authors.initials: M
authors.lastname: Jaakkola
authors.forename: J
authors.initials: J
authors.lastname: Karjalainen
authors.forename: H
authors.initials: H
authors.lastname: Oksanen
authors.forename: I
authors.initials: I
authors.lastname: Nordback
mesh_terms: D000208:Acute Disease; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010179:Pancreas / Q000473:pathology; D010195:Pancreatitis / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods