No debridement is necessary for symptomatic or infected acute necrotizing pancreatitis: delayed, mini-retroperitoneal drainage for acute necrotizing pancreatitis without debridement and irrigation.
We sought to determine if necrosectomy can be omitted for complicated acute necrotizing pancreatitis (ANP). Since 1996, we prospectively performed retroperitoneal drainage by introducing a sump drain to the pancreatic head area via a small left flank incision without debridement and irrigation on 19 consecutive complicated ANP patients. We purposely delayed surgery until liquefaction of retroperitoneal tissue reached the left flank. Our patients had a mean Ranson's and APACHE II score of 5.9 (range, 4-8) and 20.1(range, 4-45), respectively. Sixteen available CT showed retroperitoneal liquefaction after 21.3 days (range, 14-26). Operations were delayed for 4.7 weeks (range, 1.3-9.0). No patient succumbed during this period. The indications were infected necrosis in 16 and severe abdominal pain/food intolerance in 3 patients. Average skin incision was 4.0 cm (range, 3-9). Fungi or bacteria were cultured in 15 patients (80.0%). The recovery courses were surprisingly uneventful. Oral intake began within 2.4 days (range, 1-5) and mean hospital stay (16 survivals) was 23.2 days (range, 4-120) after operation. Drains were completely removed 120.6 days (range, 60-250) later from these outpatients. One gastric perforation and one minor duodenal leak were the only procedure-related complications (10.5%). Three patients died (15.8%), although one had a healed ANP. In conclusion, this delay-until-liquefaction strategy without necrosectomy is an easy and effective treatment method.
Chang
Yu-Chung
YC
Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138, Sheng Li Road, Tainan, 70428, Taiwan. changyc@mail.ncku.edu.tw
Tsai
Hong-Min
HM
Lin
Xi-Zhang
XZ
Chang
Chia-Hao
CH
Chuang
Jen Pin
JP
D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy*; D000075202:Contraindications; D003646:Debridement; D004322:Drainage / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy*; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome