Postoperative lavage and on demand surgical intervention in the treatment of acute necrotizing pancreatitis.

OBJECTIVE

To analyse our experience with a combined approach of postoperative local lavage and on demand surgical intervention in the treatment of acute necrotizing pancreatitis.

PATIENTS AND METHODS

All patients operated on for acute pancreatitis in a tertiary hospital between June 1993 and July 1997 were studied retrospectively. Demographic data, Ranson score, APACHE II score at admission were recorded. Hospital charts and clinical courses were reviewed.

RESULTS

Seventeen patients were treated surgically because of end stage multiple organ failure (MOF) (n = 13) or infected necrosis (n = 4). APACHE II and Ranson scores were 26.2 +/- 9.25 and 7.33 +/- 1.35 respectively. All patients had protracted clinical courses, and required aggressive intensive care therapy. Forty-eight surgical interventions were performed in 17 patients. Early mortality was 36 percent. Complications were numerous, and mostly consisted of intra-abdominal abscesses. Young age (under 55) was associated with significantly better outcome (22% vs. 87% mortality, p = 0.015).

CONCLUSION

Continuous local lavage after surgical debridement, with on demand re-laparotomy, proves to be a valuable approach in patients with necrotizing pancreatitis with acceptable morbidity and mortality rates. It appears however, that the role of surgery for acute pancreatitis is limited to patients with infected necrosis or end stage MOF.