Surgical Treatment of Acute Necrotizing Pancreatitis

ABSTRACT

Acute necrotizing pancreatitis (ANP) is a disease with high morbidity and mortality despite the progress made in intensive medical care. This study was conducted to clarify the strategy and the prognostic factors in its surgical management.We reviewed retrospectively 26 patients who had operative treatment for ANP from March 1990 to February 1995 at Wallace Memorial Baptist Hospital. The results were as follows:1) The most common cause of the ANP was alcohol (38.5%) and the next most common cause was gallstone (23.1%). 2) The operative indications were an acute surgical abdomen (15 cases), sepsis (6 cases), organ failure (3 cases), and shock (2 cases). 3) The culture results for the specimens which were obtained from the necrotic lesions or from fluid collections showed bacterially positive patients in 78.9% of the cases and polymicrobial infection in 31.6% of the cases. 4) Of the operative methods, a necrosectomy with open drainage and delayed lavage was applied to 17 cases (65.4%), and the mortality of this procedure was 23.5%. 5) During the postoperative course, reoperation was required in 3 cases (11.5%) and diabetes was seen in 6 cases of 22 cases (27.3%). 6) We analyzed prognostic factors like the Ranson score, infection, inadequate necrosectomy with drainage, and preoperative organ failure with statistical methods (Student's t-test and Chi-square test). The Ranson score and infection showed little correlation with the postoperative mortality, but an inadequate necrosectomy with drainage and preoperative organ failure showed a statistically significant correlation (p=0.006, p=0.009, respectively). In conclusion, we applied a necrosectomy with open drainage and delayed lavage to most of the ANP patients. An inadequate necrosectomy with drainage and preoperative organ failure had important meanings as prognostic factors and affected the postoperative mortality. Hence we think that necrotic lesions and fluid collections require early radical debridement and wide drainage, especially in infected necrotizing pancrectitis, and that multiple, well-positioned drains are important for decreased morbidity and mortality.