title: Combined anterior and posterior open treatment in infected pancreatic necrosis.
abstract: 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.
authors.affiliation: Department of Surgery, Catholic University of Sacred Heart, Rome, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Gui
authors.forename: Fabio
authors.initials: F
authors.lastname: Pacelli
authors.forename: Massimo
authors.initials: M
authors.lastname: Di Mugno
authors.forename: Matteo
authors.initials: M
authors.lastname: Runfola
authors.forename: Sabina
authors.initials: S
authors.lastname: Magalini
authors.forename: Federico
authors.initials: F
authors.lastname: Famiglietti
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Doglietto
mesh_terms: 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