Intra-abdominal vacuum-assisted closure (VAC) after necrosectomy for acute necrotising pancreatitis: preliminary experience.
Infection of pancreatic necrosis, although present in less than 10% of acute pancreatitis, carries a high risk of mortality; debridment and drainage of necrosis is the treatment of choice, followed by 'open' or 'close' abdomen management. We recently introduced the use of intra-abdominal vacuum sealing after a classic necrosectomy and laparostomy. Two patients admitted to ICU for respiratory insufficiency and a diagnosis of severe acute pancreatitis developed pancreatic necrosis and were treated by necrosectomy, lesser sac marsupialisation and posterior lumbotomic opening. Both of the patients recovered from pancreatitis and a good healing of laparostomic wounds was obtained with the use of the VAC system. Most relevant advantages of this technique seem to be: the prevention of abdominal compartment syndrome, the simplified nursing of patients and the reduction of time to definitive abdominal closure.
Sermoneta
D
D
Emergency Surgery Unit, Department of Surgery, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Roma, Italy. daniel.s@tiscali.it
Di Mugno
M
M
Spada
P L
PL
Lodoli
C
C
Carvelli
M E
ME
Magalini
S C
SC
Cavicchioni
C
C
Bocci
M G
MG
Martorelli
F
F
Brizi
M G
MG
Gui
D
D
D034841:Abdominal Cavity; D000368:Aged; D003161:Compartment Syndromes / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods* / Q000451:nursing; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods* / Q000451:nursing; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014945:Wound Healing