Pancreatic function after severe acute biliary pancreatitis: the role of necrosectomy.
OBJECTIVE
To investigate the recovery of pancreatic function after severe acute biliary pancreatitis (ABP), especially the influence of necrosectomy on endocrine and exocrine functions.


METHODS
Prospective cohort study including 39 patients with severe ABP. According to need or no need for surgical necrosectomy, patients were further subdivided into 2 groups. Functional pancreatic evaluation was carried out 12 months after the ABP episode. Endocrine function was evaluated by an oral glucose tolerance test and exocrine function by fecal fat excretion, fecal chymotrypsin (FQ), and secretin-cerulein tests (SCT).


RESULTS
Most of the patients with necrosectomy had an abnormal exocrine pancreatic function, with steatorrhea in 25%. In the group without surgery, exocrine function was pathologic in only 13.3% and there were no cases of steatorrhea. Endocrine function was pathologic in 75% of patients undergoing necrosectomy versus 26.7% in the nonoperated group. In this latter group, the patients with abnormal endocrine function did not require insulin therapy, while in 33.3% of patient in the necrosectomy group insulin was necessary.


CONCLUSIONS
In our homogeneous series of severe ABP, necrosectomy impaired significantly pancreatic endocrine and exocrine function. On the other hand, most patients with the same origin and severity index, but without surgical debridement, maintained normal pancreatic function.
Sabater
L
L
Department of General Surgery, Hospital Clínico, University of Valencia, Valencia, Spain. lso@ctv.es
Pareja
E
E
Aparisi
L
L
Calvete
J
J
Camps
B
B
Sastre
J
J
Artigues
E
E
Oviedo
M
M
Trullenque
R
R
Lledó
S
S
D000368:Aged; D001660:Biliary Tract Diseases / Q000150:complications*; D001786:Blood Glucose / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D005951:Glucose Tolerance Test; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology / Q000503:physiopathology*; D010180:Pancreatectomy; D010186:Pancreatic Function Tests; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000503:physiopathology* / Q000601:surgery; D011446:Prospective Studies; D012720:Severity of Illness Index
D001786:Blood Glucose