Surgical management of necrotizing pancreatitis.

Necrotizing pancreatitis has a formidable mortality that may exceed 55% even when treated by surgical drainage. Standard surgical techniques for controlling pancreatic sepsis are often inadequate because the unique chronicity of pancreatitis results in persistent and ongoing inflammation and sloughing of necrotic retroperitoneal tissue that promotes further sepsis. Ten consecutive high-risk patients in whom standard surgical debridement and drainage had failed were treated with open packing of the pancreatic bed. This was followed by daily debridement dressing changes at the bedside in the surgical intensive care unit. Management of the open abdomen in the surgical intensive care unit using standard surgical techniques ensured optimum wound toilet, prevented recurrent intra-abdominal sepsis, was logistically acceptable, was well tolerated by critically ill patients, and allowed a higher salvage rate (80%) of high-risk patients than might otherwise be anticipated.