Results of 21 patients with pancreatic necrosis and/or abscess treated by continous closed lesser sac or site lavage

Abstract

Purpose: The aim of this study was to evaluate the results of necrosectomy and continuous closed lavage of the lesser sac or site in the treatment of pancreatic necrosis and/or abscess.

Background: Despite in its improvement in diagnosis and treatment, acute necrotizing pancreatitis is still associated with a high incidence of mortality and morbidity. The management of sterile necrosis is still controversial. Criteria for surgical intervention in sterile necrosis and choice of technique in debridement of necrosis (conventional passive drainage, continuous lavage of the lesser sac or open abdomen) are still matters of debate.

Materials and Methods: Between February 1991 and August 2003, 21 patients with necrotizing pancreatitis were treated with necrosectomy followed by continuous closed lesser sac or site lavage.

Results: Among our patients, 11 had infected necrosis and 6 had sterile necrosis. Additionally, two patients had infected necrosis and abscess, and two had pancreatic abscesses. Eight cases of acute attack were managed at another clinic however, upon development of large necrosis or abscesses, these patients were subsequently transferred to our clinic. 13 patients were treated at our clinic right from the start. Reasons for surgery in 21 patients were as follows: absence of definite diagnosis (4), pancreatic abscesses (4), infected necrosis (4), persistence or advancement of organ complication despite intensive therapy (3), presentation of sepsis signs (3), organized necrosis (2) and symptomatic pseudocyst (1). Six patients (28.6 %) were documented with serious organ-system dysfunction. Three patients (14.3 %) died and among those who lived nine patients developed serious complications. The hospitalization period for patients who survived averaged between 10-65 days. (Mean: 34.0).

Conclusion: Infected pancreatic necrosis and/or abscess can be treated surgically; but management of sterile necrosis is still controversial. Conservative strategies can be applied succesfully to manage most patients with sterile necrosis. Necrosectomy supplemented by postoperative closed continuous lavage of the site not only offers debridement of devitalized tissue, but also prevents development of new necrosis through nonsurgical removal of necrotic tissue and biologically active and bacterial compounds.