title: Changing role of surgery in necrotizing pancreatitis: a single-center experience.
abstract: OBJECTIVE
  The incidence of acute pancreatitis varies from 5 to 80 per 100,000 inhabitants throughout the world. Recognizing the natural course of severe acute pancreatitis a multidisciplinary approach had become the standard. The strategy of postponing surgical intervention was implemented in the treatment algorithm several years ago.
  
  
  METHODS
  A retrospective analysis of patient data from two five-year periods. The first period was from 01/1992 to 12/1997 (group 1), the second period from 10/2001 to 12/2006 (group 2).
  
  
  RESULTS
  In this study, we retrospectively analyzed the impact of this approach on the outcome of our patients with necrotizing pancreatitis. The time interval between onset of disease and first necrosectomy was in the mean 19.5 days in patients of group 1 and 30 days in group 2 (p = 0.015). In group 1, 45/78 patients (57%) were operated on during the first 14 days compared to 8/32 patients (25%; p = 0.002) in group 2. The mortality was 41% in group 1 and 18% in group 2 (p = 0.026). There was also a statistically significant decrease in mortality when first necrosectomy was postponed after day 29 (p = 0.015).
  
  
  CONCLUSIONS
  Our results are in line with several other analyses suggesting that the strategy of postponing surgery in patients with necrotizing pancreatitis is associated with a decreased mortality.
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University Hospital, Steinhoevelstr. 9, 89075 Ulm, Germany. mathias.wittau@uniklinik-ulm.de
authors.forename: Mathias
authors.initials: M
authors.lastname: Wittau
authors.forename: Jan
authors.initials: J
authors.lastname: Scheele
authors.forename: Ingo
authors.initials: I
authors.lastname: Gölz
authors.forename: Doris
authors.initials: D
authors.lastname: Henne-Bruns
authors.forename: Rainer
authors.initials: R
authors.lastname: Isenmann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents