Pancreatic necrosectomy morbid but life saving

Abstract

Introduction: Pancreatic necrosectomy has high morbidity and hence is the last resort in necrotizing pancreatitis. Retrospective analysis was done to study its morbidity and sequalae Method: Between 2005 to 2017, 110 patients underwent closed pancreatic necrosectomy. After adequate debridement and washes, multiple tube drains were kept for postoperative irrigation. Need for diversion stoma and feeding jejunostomy was decided on clinical, radiological and intraoperative findings. Results: 93 males & 17 females. Mean age was 36 years (21–77). Pancreatic necrosis was due to alcohol-56, biliary -44 , whereas trauma and idiopathic 3 each ,post ercp and autoimmune pancreatitis -2 each. 53/110 ( 48%) pts had diversion stoma . 68/110 (62 %) patients had feeding jejunostomy. Preoperative percutaneous drainage was done in 35 patients. Average time of intervention was 54th day since onset of pancreatitis. Average amount of necrotic material was 62 gms. Necrotic fluid grew e.coli in 48, klebsiella in 26, pseudomonas in 9. Average post op stay 23 days.(8-70). Post op prolonged ventilation(>48 hrs) required in 28 patients. 11 patients required tracheostomy. 12/ 110(11%) patients had mortality. 49/110 (45%) patients had pancreatic fistula, out of which 30 required postoperative ERCP and pancreatic duct stenting, for the fistula to heal. New onset DM and incisional hernia was seen in 10 and 5 patients respectively. Conclusion: Surgical pancreatic necrosectomy done after 6-7 weeks is less morbid. Diversion stoma and feeding jejunostomy are often required. ERCP and PD stenting are required for prolonged pancreatic fistulae to heal.