Necrotising Pancreatitis- A Cross-sectional Study on Surgical Outcomes of Pancreatic Necrosectomy

Abstract

Introduction: Necrotising Pancreatitis (NP) is the severe form of acute pancreatitis accounting for significant mortality (15- 40%), morbidity (~25%) and has significant health costs. The traditional management of infected necrosis has centered on open surgical debridement which is accompanied by significant risk of stress, organ failure and complications. Short-term and long-term functional outcomes after operative treatment of NP have not been studied extensively. Aim: To evaluate the short-term and long-term surgical outcomes in patients undergoing surgery for NP. Materials and Methods: This was a cross-sectional study of patients who underwent surgery for NP conducted at Manipal Hospital, Bangalore between June 2009 to March 2016. The electronic records pertaining to such patients were retrieved. Various surgeries done were grouped. Surgical complications and short-term outcomes like new onset organ failure, Surgical Site Infection (SSIs), haemorrhage, bowel fistula, re-explorations, and requirement of additional procedures, hospital stay and the mortality were studied by hospital data. Long-term outcomes like endocrine/exocrine insufficiency, weight loss, recurrent pancreatitis, incision hernia were studied by prospective data collected from telephonic interview; questionnaires in addition to data collected as and when patient gets admitted and in Outpatient Department (OPD) during follow-up. A comparison with different surgical techniques like laparoscopy, open necrosectomy, Video assisted necrosectomy was made. Statistical analyses were performed by STATA 11.2 (College Station TX USA). Mann-Whitney test were used to find the significance difference between the length of stay and Intensive Care Unit (ICU) stay with the groups and it is expressed as mean and standard deviation, Chi-square test has been used to measure the association between different clinical variables. p<0.05 was considered as statistically significance. Results: Forty six patients underwent surgical treatment during the study period. Patients’ age ranged from 25 to 75 years (median age- 44 years). Median postoperative ICU stay was 12 days (range of 01- 32 days). The mean follow-up was 3.5 years. The overall mortality rate was 26% (12 patients). The mortality rates between laparatomy (33%) and minimally invasive necrosectomy (23%) groups were not significantly different (p=0.436). Secondary diabetes mellitus was observed in 18 (40%) and exocrine insufficiency in 8 (18%) of patients. The other long-term complications were recurrent pancreatitis in 7 (15%), biliary stricture 3 (6%) and incisional hernia in 3 (6%). Conclusion: Mortality rate, organ failure rates and median ICU admission rate were similar across all surgical techniques though there was a trend of overall reduced complication rate. A long-term and close follow-up is advised in these patients for the late complications to be identified and treated.