Morphological and functional outcome after pancreatic necrosectomy and lesser sac lavage for necrotizing pancreatitis.

BACKGROUND

Immediate outcomes after pancreatic necrosectomy have improved in recent years. This study reviews our short-term to medium-term experience of structural and functional changes in the pancreas after necrosectomy.

METHODS

Ten patients (8 males, median age 35 years), discharged after pancreatic necrosectomy for acute necrotizing pancreatitis between 1996 and 1998 were reviewed after a median period of 22 months. Clinical evidence of pancreatic dysfunction was documented at follow-up interview. Patients underwent computed tomography of the abdomen, endoscopic retrograde pancreatography, oral glucose tolerance test, fecal fat estimation and fasting serum C-peptide estimation (CPE).

RESULTS

No patient had repeat episodes of pancreatitis during the follow-up period. Three patients developed de-novo diabetes after discharge. No patient had symptoms of steatorrhea. Five patients showed severe changes on CECT. ERCP showed marked changes in six patients, the commonest being an abrupt cut-off of the main pancreatic duct. Glucose tolerance was abnormal in three patients and impaired in two patients while fecal fat excretion was abnormal in 8 patients.

CONCLUSIONS

Severe acute pancreatitis and necrosectomy are associated with significant structural and functional changes on medium-term follow-up.