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.
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.
Authors: Andrew W Kirkpatrick; Federico Coccolini; Luca Ansaloni; Derek J Roberts; Matti Tolonen; Jessica L McKee; Ari Leppaniemi; Peter Faris; Christopher J Doig; Fausto Catena; Timothy Fabian; Craig N Jenne; Osvaldo Chiara; Paul Kubes; Braden Manns; Yoram Kluger; Gustavo P Fraga; Bruno M Pereira; Jose J Diaz; Michael Sugrue; Ernest E Moore; Jianan Ren; Chad G Ball; Raul Coimbra; Zsolt J Balogh; Fikri M Abu-Zidan; Elijah Dixon; Walter Biffl; Anthony MacLean; Ian Ball; John Drover; Paul B McBeth; Juan G Posadas-Calleja; Neil G Parry; Salomone Di Saverio; Carlos A Ordonez; Jimmy Xiao; Massimo Sartelli Journal: World J Emerg Surg Date: 2018-06-22 Impact factor: 5.469
Authors: Ari Leppäniemi; Matti Tolonen; Antonio Tarasconi; Helmut Segovia-Lohse; Emiliano Gamberini; Andrew W Kirkpatrick; Chad G Ball; Neil Parry; Massimo Sartelli; Daan Wolbrink; Harry van Goor; Gianluca Baiocchi; Luca Ansaloni; Walter Biffl; Federico Coccolini; Salomone Di Saverio; Yoram Kluger; Ernest Moore; Fausto Catena Journal: World J Emerg Surg Date: 2019-06-13 Impact factor: 5.469