Early and long term results of necrosectomy and planned re-exploration for infected pancreatic necrosis.
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.
van Goor
H
H
Department of Surgery, University Hospital Groningen, The Netherlands.
Sluiter
W J
WJ
Bleichrodt
R P
RP
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