Surgical therapy of severe acute pancreatitis: a flexible approach gives excellent results.

BACKGROUND/AIMS: To evaluate the effectiveness of our surgical strategy in acute and necrotizing pancreatitis we performed this prospective uncontrolled study.

METHODOLOGY

Seventy-six patients with severe acute pancreatitis who were operated on between 1989 and 1995 were included in this study. Laparotomy aimed at removal of necrosis, treatment of ongoing necrosis, and correction of concurrent pathology were the principal goals of surgery. This required multiple interventions in 36 patients.

RESULTS

Sixty-nine patients with a mean Ranson score of 3 survived, while 7 patients with a mean score of 7 died (9.2% overall mortality). Fifty-six patients (74%) underwent necrosectomy, followed by continuous lavage in 31 cases and laparostomy (provisional closure of abdominal cavity with absorbable mesh) with staged revisions in 14. Necroses were infected in 39% of initial operations. Twenty-two patients had to be re-operated without being scheduled for planned revisions, mostly for abscess formation, bleeding or intestinal ischemia. Mortality of necrotizing pancreatitis was 12.5%.

CONCLUSIONS

Surgical therapy of acute necrotizing pancreatitis has to be tailored to the intra- and post-operative situations. In cases of massive or ongoing necrosis, the goal of surgical therapy will not be achieved by a singular intervention but has to be complemented with further treatment.