Pancreatic Necrosectomy

Abstract

Acute pancreatitis is a significant cause of morbidity and mortality in the United States, occurring in approximately 44 per 100,000 adults and accounting for more than 200,000 hospital admissions each year [ [1] Frossard J. Steer M.L. Pastor C.M. Acute pancreatitis. Lancet. 2008; 371: 143-152 Abstract Full Text Full Text PDF PubMed Scopus (610) Google Scholar ]. Of those patients, more than 80% have a benign course and recover without significant morbidity or recurrence [ [2] Lund H. Tønnesen H. Tønnesen M.H. Olsen long-term recurrence and death rates after acute pancreatitis. Scand J Gastroenterol. 2006; 41: 234-238 Crossref PubMed Scopus (89) Google Scholar ]. However, in the minority of patients who suffer complications, the outcomes can be devastating. The most feared complication is the development of pancreatic necrosis, which is estimated to occur in 10% to 25% of all cases of acute pancreatitis [ 3 Sakorafas G. Tsiotos G.G. Sarr M.G. Extrapancreatic necrotizing pancreatitis with viable pancreas: a previously under-appreciated entity. J Am Coll Surg. 1999; 188: 643-648 Abstract Full Text Full Text PDF PubMed Scopus (93) Google Scholar , 4 Rau B. Bothe A. Beger H.G. Surgical treatment of necrotizing pancreatitis by necrosectomy and closed lavage: changing patient characteristics and outcome in a 19-year, single-center series. Surgery. 2005; 138: 28-39 Abstract Full Text Full Text PDF PubMed Scopus (172) Google Scholar ]. The risk of mortality from necrotizing pancreatitis has been estimated between 10% and 20% [ 5 Hartwig W. Maksan S.M. Foitzik T. et al. Reduction in mortality with delayed surgical therapy of severe pancreatitis. J Gastrointest Surg. 2002; 6: 481-487 Crossref PubMed Scopus (157) Google Scholar , 6 Ashley S. Perez A. Pierce E.A. et al. Necrotizing pancreatitis: contemporary analysis of 99 consecutive cases. Ann Surg. 2001; 234: 572-579 Crossref PubMed Scopus (200) Google Scholar , 7 Besselink M. de Bruijn M.T. Rutten J.P. et al. Surgical intervention in patients with necrotizing pancreatitis. Br J Surg. 2006; 93: 593-599 Crossref PubMed Scopus (98) Google Scholar ] compared with an overall mortality of at most 5% to 10% for acute pancreatitis in general [ [8] Triester S. Kowdley K.V. Prognostic factors in acute pancreatitis. J Clin Gastroenterol. 2002; 34: 167-176 Crossref PubMed Scopus (109) Google Scholar ]. In those patients who develop necrosis, mortality is bimodal in its temporal distribution [ 9 Jamdar S. Siriwardena A.K. Contemporary management of infected necrosis complicating severe acute pancreatitis. Crit Care. 2006; 10: 101 Crossref PubMed Scopus (11) Google Scholar , 10 Fu C. Yeh C.N. Hsu J.T. et al. Timing of mortality in severe acute pancreatitis: experience from 643 patients. World J Gastroenterol. 2007; 13: 1966-1969 PubMed Google Scholar ]. Early deaths are attributed mostly to severe multisystem organ failure within the first few days of onset [ [11] McKay C. Imrie C.W. The continuing challenge of early mortality in acute pancreatitis. Br J Surg. 2004; 91: 1243-1244 Crossref PubMed Scopus (101) Google Scholar ], whereas late deaths tend to occur in the setting of infection and systemic sepsis [ 10 Fu C. Yeh C.N. Hsu J.T. et al. Timing of mortality in severe acute pancreatitis: experience from 643 patients. World J Gastroenterol. 2007; 13: 1966-1969 PubMed Google Scholar , 12 Beger H. Rau B.M. Severe acute pancreatitis: clinical course and management. World J Gastroenterol. 2007; 13: 5043-5051 Crossref PubMed Scopus (196) Google Scholar ].