Abstract |
We sought to determine if necrosectomy can be omitted for complicated acute necrotizing pancreatitis ( ANP). Since 1996, we prospectively performed retroperitoneal drainage by introducing a sump drain to the pancreatic head area via a small left flank incision without debridement and irrigation on 19 consecutive complicated ANP patients. We purposely delayed surgery until liquefaction of retroperitoneal tissue reached the left flank. Our patients had a mean Ranson's and APACHE II score of 5.9 (range, 4-8) and 20.1(range, 4-45), respectively. Sixteen available CT showed retroperitoneal liquefaction after 21.3 days (range, 14-26). Operations were delayed for 4.7 weeks (range, 1.3-9.0). No patient succumbed during this period. The indications were infected necrosis in 16 and severe abdominal pain/ food intolerance in 3 patients. Average skin incision was 4.0 cm (range, 3-9). Fungi or bacteria were cultured in 15 patients (80.0%). The recovery courses were surprisingly uneventful. Oral intake began within 2.4 days (range, 1-5) and mean hospital stay (16 survivals) was 23.2 days (range, 4-120) after operation. Drains were completely removed 120.6 days (range, 60-250) later from these outpatients. One gastric perforation and one minor duodenal leak were the only procedure-related complications (10.5%). Three patients died (15.8%), although one had a healed ANP. In conclusion, this delay-until-liquefaction strategy without necrosectomy is an easy and effective treatment method.
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Authors | Yu-Chung Chang, Hong-Min Tsai, Xi-Zhang Lin, Chia-Hao Chang, Jen Pin Chuang |
Journal | Digestive diseases and sciences
(Dig Dis Sci)
Vol. 51
Issue 8
Pg. 1388-95
(Aug 2006)
ISSN: 0163-2116 [Print] United States |
PMID | 16855881
(Publication Type: Comparative Study, Journal Article)
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Topics |
- Aged, 80 and over
- Bacterial Infections
(diagnostic imaging, microbiology, therapy)
- Contraindications
- Debridement
- Drainage
(methods)
- Follow-Up Studies
- Humans
- Pancreatitis, Acute Necrotizing
(diagnostic imaging, microbiology, therapy)
- Retroperitoneal Space
- Retrospective Studies
- Therapeutic Irrigation
- Tomography, X-Ray Computed
- Treatment Outcome
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