Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique.
METHODS
From 1983 to 1995, 72 patients with necrotizing pancreatitis were treated with a general approach involving planned reoperative necrosectomies and interval abdominal wound closure using a zipper.


RESULTS
Hospital mortality was 25%. Multiple organ failure without sepsis caused early mortality in 3 of 4 patients and sepsis caused late mortality in 11 of the remaining 14. The mean number of reoperative necrosectomies/debridements was 2 (0 to 7). Fistulae developed in 25 patients (35%); 64% were treated conservatively. Recurrent intraabdominal abscesses developed in 9 patients (13%) but were drained percutaneously in 5. Hemorrhage required intervention in 13 patients (18%). Prognostic factors included APACHE-II score on admission < 13 (P = 0.005), absence of postoperative hemorrhage (P = 0.01), and peripancreatic tissue necrosis alone (P < 0.05).


CONCLUSIONS
The zipper approach effectively maximizes the necrosectomy and decreases the incidence of recurrent intraabdominal infection requiring reoperation. APACHE-II score > or = 13, extensive parenchymal necrosis, and postoperative hemorrhage signify worse outcome.
Tsiotos
G G
GG
Department of Surgery, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
Luque-de León
E
E
Söreide
J A
JA
Bannon
M P
MP
Zietlow
S P
SP
Baerga-Varela
Y
Y
Sarr
M G
MG
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003646:Debridement; D004322:Drainage / Q000379:methods; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000601:surgery*; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation; D014057:Tomography, X-Ray Computed