Management of necrotizing pancreatitis: flexible approach depending on intra-operative assessment of necrosis.
BACKGROUND
The surgical management of necrotizing pancreatitis (NP) has changed over the years.


METHODS
Among 144 patients, 12.5% (n = 18) were treated conservatively and 87.5% (n = 126) underwent surgery. The choice of operative method depended on the intra-operative assessment of consistency and on the extent of necrosis. A group of 126 patients underwent necrosectomy, followed by laparostomy with open packing in 80% (n = 101) cases, drainage in 14% (n = 18) and continuous closed lavage in 6% (n = 7).


RESULTS
Postoperative complications occurred in 42.8% (n = 54) of the patients who underwent the surgery. Hospital mortality rate over all patients was 18% and 20.6% (n = 26) in the group of patients who underwent the surgery. Mean hospital stay was 61 +/- 36 days. Patients managed conservatively (n = 18) were discharged without surgical intervention. In this group no complications or deaths were observed.


CONCLUSIONS
Using the three different surgical techniques in the management of NP, depending on intra-operative assessment of necrosis, showed promising results. A flexible approach targeted at a single patient and tailored to the clinical course and intra-operative situation should be considered in the treatment of NP.
Olakowski
M
M
Department of Digestive Tract Surgery, Silesian Medical University, Katowice, Poland. olakom@mp.pl
Dranka-Bojarowska
D
D
Szlachta-Swiatkowska
E
E
Lekstan
A
A
Lampe
P
P
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003646:Debridement / Q000379:methods*; D013505:Digestive System Surgical Procedures; D004322:Drainage; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D018579:Patient Selection; D011183:Postoperative Complications; D007507:Therapeutic Irrigation