Direct retroperitoneal open drainage via a long posterior oblique incision for infected necrotizing pancreatitis: report of three cases.

Although several surgical approaches have been advocated for patients with infected necrotizing pancreatitis, there is still a high incidence of morbidity and mortality. We used a new approach of direct retroperitoneal open drainage after various other treatments, for three patients with necrotizing pancreatitis and extended infection with multiple-organ failure. Long oblique incisions were made from the root of the 12th rib to the anterior superior spina iliaca on the left or right side of the back, or both, to approach the retroperitoneal area of infected necrosis. The necrotic tissue was removed bluntly and the wound was laid open. Lavage and debridement were done repeatedly after the operation. The patients recovered from multiple-organ failure within 2 weeks, and control of local infection was achieved within 3-4 weeks. All three patients were discharged and are now well. Therefore, we propose that this method is appropriate for patients with spreading infected necroses, who are in poor general condition.