A contemporary series of patients undergoing open debridement for necrotizing pancreatitis.

Abstract

BACKGROUND:

For patients with acute pancreatitis complicated by infected necrosis, minimally invasive techniques have taken hold without substantial comparison with open surgery. We present a contemporary series of open necrosectomies as a benchmark for newer techniques.

METHODS:

Using a prospective database, we retrospectively identified consecutive patients undergoing debridement for necrotizing pancreatitis (2006 to 2009). The primary endpoint was in-hospital mortality.

RESULTS:

Sixty-eight patients underwent debridement for pancreatic/peripancreatic necrosis. In-hospital mortality was 8.8% (n = 6). Infection (n = 43, 63%) and failure-to-thrive (n = 13, 19%) comprised the most common indications for necrosectomy. The false negative rate (FNR) for infection of percutaneous aspirate was 20.0%. Older age (P = .02), Acute Physiology and Chronic Health Evaluation II score upon admission (P = .03) or preoperatively (P < .01), preoperative intensive care unit admission (P = .01), and postoperative organ failure (P = .03) were associated with mortality.

CONCLUSIONS:

Open debridement for necrotizing pancreatitis results in a low mortality, providing a useful comparator for other interventions. Given the high FNR of percutaneous aspirate, debridement should not be predicated on proven infection.

• Authors: Arin L Madenci, Maria Michailidou, Grace Chiou, Ashraf Thabet, Carlos Fernández-del Castillo, Peter J Fagenholz
• Journal: American journal of surgery (Am J Surg) Vol. 208 Issue 3 Pg. 324-31 (Sep 2014) ISSN: 1879-1883 [Electronic] United States
• PMID: 24767969 (Publication Type: Evaluation Study, Journal Article)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Topics

• Debridement (methods)
• Female
• Hospital Mortality
• Humans
• Male
• Middle Aged
• Pancreatitis, Acute Necrotizing (mortality, surgery)
• Retrospective Studies
• Treatment Outcome