Surgical approaches for treatment of infected acute necrotizing pancreatitis (original) (raw)
Necrotizing Acute Pancreatitis (NAP) complicated by infection is a very serious disease resulting in multi-organ failure. It is still associated with a very high mortality. The aim of our study was to evaluate of Infected Necrotizing Acute Pancreatitis (INAP) in patients treated with the various surgical approaches. We retrospectively reviewed twentythree patients with INAP, who were surgically treated, in order to assess the results of the surgical treatment between 1995 and 2005. Of the cases mentioned, 15 were male while the rest (8 cases) being female (average 52 years of age, range 44-78). The average APACHE II score for whole study group (after 48 h) was 12.8. Operative procedures consisted of external drainage (ED) in 11 cases (48%) and necrosectomy with continuous local lavage (NCL) in 12 cases (52%). The overall mortality rate was 21 percent (n=5). In the group with fatal outcome, first operation performed was ED in three cases and NCL in two cases. The reason for death was multi-organ failure in all patients. During a median follow-up of 20.4 months, 9 (39%) out of 23 patients had one or more late complications: pseudocyst in 5 (21%), pancreatic fistula in 2 (9%), delayed collection in 1 (4%) and incisional hernia in 1 (4%). In patients with infected necrosis who deteriorate during conservative treatment, NCL may be an option with acceptable morbidity, re-operation and mortality rates. We believe that complications during surgical therapy of acute infected necrotizing pancreatitis are carrying high risk factors, but their treatment is not hopeless.
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