Abstract
Introduction: Minimally invasive approaches to debridement of pancreatic sepsis are increasingly reported but their adoption is as yet unsupported by randomized trial evidence. This report provides data on contemporary outcome of pancreatic necrosis managed by a protocol of fine-needle-aspiration (FNA) guided management and open necrosectomy. Methods: 124 patients with clinically severe acute pancreatitis were admitted to critical care over the period January 2000 to January 2006. Of these, 26 patients who underwent open necrosectomy constitute the dataset. The median (range) age was 50 (20-77) years. Aetiology was biliary in 13 and alcohol in 13. The median logistic organ dysfunction score-predicted mortality on admission was 4.8% which increased to 7.1% immediately prior to surgery. All patients received antibiotics and 19 (73%) had antifungal treatment. FNA was undertaken prior to surgery in 19 (73%) with positive results in 14. Results: Surgery was via midline in 16 and transverse in 10. No patients had additional mobilisation of colonic flexure, t-tube drainage of common bile duct or decompressing gastrostomy. Synchronous cholecystectomy was undertaken in 11 (48%). All patients had abdominal drains. Lesser sac irrigation was not employed. In-hospital stay was 84 (28-193) days and there were 5 (19%) deaths. Discussion: Open necrosectomy has evolved and is now a lesser procedure targeted at draining the focus of infection and blunt debridement. Acceptable outcomes in critically ill patients suggest that this is the standard to which minimally invasive operations should be compared.
Published Version
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