title: Open transgastric debridement and internal drainage of symptomatic non-infected walled-off pancreatic necrosis.
abstract: BACKGROUND
  The best treatment options for walled-off pancreatic necrosis (WOPN) are not well defined. A retrospective study of patients treated for WOPN with transgastric debridement and internal drainage was undertaken.
  
  
  METHODS
  Patients with symptomatic non-infected WOPN treated with open transgastric debridement and internal drainage were evaluated.
  
  
  RESULTS
  In all, 51 patients underwent surgical management of necrotizing pancreatitis during the study period. Ten patients (19%) were treated with open transgastric debridement and internal drainage for symptomatic non-infected WOPN. The median patient age was 40 years, the most common aetiology for pancreatitis was biliary, the mean American Society of Anesthesiologists (ASA) score was 2 and the delay to surgery was 100 days. The operating time was 118 min, with a blood loss of 50cc. One patient required reoperation, three patients had morbidity and there were no mortalities. The only factor associated with post-operative morbidity was the presence of positive cultures (P < 0.05). The length of stay (LOS) after surgery was 8 days, at a median follow-up of 18 months, one patient had late complications related to the surgery and the procedure was successful in 90% of the patients.
  
  
  CONCLUSIONS
  Open transgastric debridement with internal drainage of WOPN is safe and efficacious. Patients were clinically stable (no organ failure) and had a long delay in surgical intervention (100 days). In this select group of patients, the success, morbidity and mortality is similar to all reported minimally invasive techniques.
authors.affiliation: Division of General Surgery, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Gitonga
authors.initials: G
authors.lastname: Munene
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
authors.forename: Francis
authors.initials: F
authors.lastname: Sutherland
mesh_terms: D000328:Adult; D000368:Aged; D000416:Alberta; D003646:Debridement / Q000009:adverse effects / Q000379:methods*; D004322:Drainage / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult