Open pancreatic necrosectomy in the multidisciplinary management of postinflammatory necrosis.
OBJECTIVE
To examine clinical outcome in a consecutive cohort of patients undergoing open necrosectomy for postinflammatory necrosis.


BACKGROUND
The last decade has witnessed major developments in the surgical management of pancreatic necrosis. Minimally invasive approaches have become established. However, there are limited data from contemporary open necrosectomy, in particular where multidisciplinary care and aggressive interventional radiology are used. This report provides data on outcome from open necrosectomy in a tertiary referral Hepatobiliary unit over the last decade.


METHODS
During the period January 1, 2000 to July 31, 2008, 1535 patients were admitted with a final discharge code of acute pancreatitis. Twenty-eight (1.8%) of all admissions underwent open surgical necrosectomy. Twenty-four (86%) were tertiary referral patients.


RESULTS
The median APACHE II score on admission was 10.5 (5-26). Median logistic organ dysfunction score on admission was 3 (0-10). Median LODS score after surgery was 2 (0-8). Twenty patients (71%) underwent radiologically guided drainage of collections before surgery. Thirty-day mortality occurred in 2 (7%), 4 further deaths occurred in patients after discharge from intensive care resulting in a total of 6 (22%) episode-related deaths.


CONCLUSIONS
Modern open necrosectomy can be performed without the procedure-related deterioration in organ dysfunction associated with major debridement. Multidisciplinary care with an emphasis on aggressive radiologic intervention before and after surgery results in acceptable outcomes in this cohort of critically ill patients. Newer laparoscopic techniques must demonstrate similar outcomes in the setting of stage-matched severity before wider acceptance.
Babu
Benoy I
BI
Hepatobiliary Surgical Unit, Department of Radiology, Manchester Royal Infirmary, Manchester, United Kingdom.
Sheen
Aali J
AJ
Lee
Stephen H
SH
O'Shea
Sarah
S
Eddleston
Jane M
JM
Siriwardena
Ajith K
AK
D018806:APACHE; D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010182:Pancreatic Diseases / Q000601:surgery; D010185:Pancreatic Fistula / Q000453:epidemiology; D019283:Pancreatitis, Acute Necrotizing / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D010348:Patient Care Team; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome