Necrosectomy with an ultrasonic dissector in the treatment of necrotizing pancreatitis.
BACKGROUND
The surgical techniques for the treatment of necrotizing pancreatitis (NP) are varied and the ideal method is still debated.


METHODS
Necrosectomy with an ultrasound dissector was performed. After the necrotic tissue was removed the bed was filled with a gentamicin-containing sponge. In the upper part of the abdominal wound a laparostomy was formed. The laparostomic cavity was packed with Mikulicz pads with physiological saline. Packs were changed every 24-48 h.


RESULTS
There were 43 patients in the study with a mean age of 54 years (range 33-77). Reasons for surgical treatment were sterile necrosis- 53.5% (n = 23), infected necrosis- 39.5% (n = 17), abscess- 7% (n = 3). The mean number of packing changes under sedation was 5 (range 1-19). Postoperative complications occurred in 25.6% of patients (n = 11). There were five deaths (11.6%) after surgery.


CONCLUSIONS
Necrosectomy with an ultrasonic dissector and gentamicin-containing sponge inserted into the post-necrotic bed are effective and well tolerated in the open packing treatment of NP.
Lampe
P
P
Department of Digestive Tract Surgery, Silesian Medical University, Katowice, Poland.
Olakowski
M
M
Lekstan
A
A
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement / Q000295:instrumentation* / Q000379:methods*; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D015503:Surgical Sponges; D016019:Survival Analysis; D014464:Ultrasonic Therapy / Q000295:instrumentation*
D000900:Anti-Bacterial Agents; D005839:Gentamicins