Combined anterior and posterior open treatment in infected pancreatic necrosis.
OBJECTIVE
To compare the results of combined anterior and posterior open treatments (lesser sac marsupialization (LSM) + lumbostomy, LSM + L) in patients with infected pancreatic necrosis (IPN) with a previous experience of isolated LSM and with data in literature.


METHODS
Thirty-four consecutive patients operated on for IPN from 1981 to 2005 were divided into two groups based on the surgical technique used: single LSM (n = 23; period A, 1981-1998) and combined LSM + L (n = 11; period B, 1999-2005).


RESULTS
The postoperative mortality rate was 38.1 (n = 8) and 9% (n = 1) during period A and B, respectively. The most important cause of death was recurrent or persistent sepsis with multiple organ failure. The overall postoperative surgical morbidity was 57 (n = 13) and 27.2% (n = 3) in the two consecutive groups.


CONCLUSIONS
IPN is a challenging condition associated with high mortality mainly because of a persistence of sepsis despite surgery. A comparative analysis of many proposed operative procedures is difficult because of the heterogeneity in the reported series. Open approaches seem to be more effective in controlling local infection and systemic sepsis. Combining open anterior and posterior approaches is in our experience an appropriate surgical treatment in IPN patients.
Gui
Daniele
D
Department of Surgery, Catholic University of Sacred Heart, Rome, Italy.
Pacelli
Fabio
F
Di Mugno
Massimo
M
Runfola
Matteo
M
Magalini
Sabina
S
Famiglietti
Federico
F
Doglietto
Giovanni B
GB
D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D005260:Female; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D010529:Peritoneal Cavity / Q000601:surgery; D010533:Peritoneal Lavage; D018805:Sepsis / Q000401:mortality / Q000601:surgery*; D013396:Suction / Q000379:methods; D014057:Tomography, X-Ray Computed; D055815:Young Adult