title: Early and long term results of necrosectomy and planned re-exploration for infected pancreatic necrosis.
abstract: OBJECTIVE
  To evaluate the early and long term results of necrosectomy, planned re-explorations and open drainage in patients with infected pancreatic necrosis.
  
  
  METHODS
  Retrospective and case control study.
  
  
  METHODS
  University hospital, The Netherlands.
  
  
  METHODS
  10 patients with documented infected pancreatic necrosis (Balthazar D and E) and 6 matched healthy volunteers who served as controls for assessment of pancreatic endocrine function.
  
  
  METHODS
  Planned re-explorations 24-hourly until necrosis was completely removed. At follow-up after 3 years intravenous glucose tolerance test in surviving patients and in healthy volunteers.
  
  
  METHODS
  Mortality, intra-abdominal complications, long term pancreatic exocrine and endocrine function.
  
  
  RESULTS
  Three patients died of multiple organ dysfunction. No patient developed a residual intra-abdominal abscess. Half of the patients developed complications including intra-abdominal haemorrhage, necrosis of the transverse colon and enterocutaneous fistula. One patient had steatorrhoea, another developed insulin dependent diabetes mellitus. Patients had impaired glucose tolerance but significantly (p < 0.05) raised glucagon and insulin concentrations compared with matched healthy volunteers.
  
  
  CONCLUSIONS
  This treatment prevents residual intra-abdominal abscesses in patients with infected pancreatic necrosis but is associated with high morbidity. Surviving patients have impaired glucose tolerance, surprisingly accompanied by increased serum insulin and glucagon concentrations.
authors.affiliation: Department of Surgery, University Hospital Groningen, The Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: van Goor
authors.forename: W J
authors.initials: WJ
authors.lastname: Sluiter
authors.forename: R P
authors.initials: RP
authors.lastname: Bleichrodt
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001424:Bacterial Infections / Q000175:diagnosis / Q000601:surgery; D016022:Case-Control Studies; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000201:enzymology; D010180:Pancreatectomy / Q000379:methods*; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D012086:Reoperation; D012189:Retrospective Studies; D015996:Survival Rate