Open Approach in Pancreatic and Infected Pancreatic Necrosis: Laparostomies and Preplanned Revisions

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 1991 Jul 1

PMID 1891938

Citations 10

Authors

R Fugger

F Schulz

M Rogy

F Herbst

D Mirza

A Fritsch

Affiliations

Soon will be listed here.

Abstract

One hundred and two patients with acute necrotizing pancreatitis were treated in accordance with a combined regimen of necrosectomy, open drainage by laparostomies, and repeated re-explorations. The severity of pancreatitis was assessed by the APACHE II score (median 15 on admission). Eighty-seven (85%) patients were classified as having infected pancreatic necrosis and only 15 (15%) as having pancreatic necrosis. Overall, 36 (35%) patients died, most of multiple organ failure. Survival was significantly impaired by bacterial contamination of pancreatic necrosis (p = 0.008), bacteremia (p = 0.0001) and infected bronchial secretions (p = 0.05). The mortality rate was reduced from 53% to 28% by changing the regimen of re-explorations from on demand to regular 48 hour intervals. Despite the fact that open packing was associated with a high frequency of gastrointestinal fistulas (30%), this concept seems to be a successful and recommendable approach in the therapy of pancreatic and infected pancreatic necrosis.

Citing Articles

Endoscopic Management of Peri-Pancreatic Fluid Collections.

Yip H, Teoh A Gut Liver. 2017; 11(5):604-611.

PMID: 28494574 PMC: 5593321. DOI: 10.5009/gnl16178.

The open abdomen, indications, management and definitive closure.

Coccolini F, Biffl W, Catena F, Ceresoli M, Chiara O, Cimbanassi S World J Emerg Surg. 2015; 10:32.

PMID: 26213565 PMC: 4515003. DOI: 10.1186/s13017-015-0026-5.

Laparoscopic pancreatic resections.

Bausch D, Keck T Langenbecks Arch Surg. 2013; 398(7):939-45.

PMID: 24006117 DOI: 10.1007/s00423-013-1108-z.

Necrotizing pancreatitis: a surgical approach independent of documented infection.

Harris H, Barcia A, Schell M, Thoeni R, Schecter W HPB (Oxford). 2008; 6(3):161-8.

PMID: 18333070 PMC: 2020671. DOI: 10.1080/13651820410033634.

No debridement is necessary for symptomatic or infected acute necrotizing pancreatitis: delayed, mini-retroperitoneal drainage for acute necrotizing pancreatitis without debridement and irrigation.

Chang Y, Tsai H, Lin X, Chang C, Chuang J Dig Dis Sci. 2006; 51(8):1388-95.

PMID: 16855881 DOI: 10.1007/s10620-006-9112-6.

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