RESULTS OF NECROSECTOMY IN PATIENTS WITH PANCREATIC NECROSIS
ÖMER ŞAKRAK, ABDULKADİR BEDİRLİ, MUSTAFA KEÇELİ, ÖZHAN İNCE
Erciyes Üniversitesi Tıp Fakültesi, Genel Cerrahi Anabilim Dalı, KAYSERİ
The aim of this study is to review results of surgical treatment in patients with pancreatic necrosis. Despite recent advances in intensive care, imaging techniques and surgical strategies, the mortality rate of pancreatic necrosis is still high. In this report, the records of 18 patients (8 men, 10 women) who underwent surgical debridement for pancreatic necrosis at the Erciyes University Hospital from 1990to 1999 were reviewed retrospectively. Mean age was 52 (range 28 to 87), The etiology of acute pancreatitis was gallstones in eleven patients (61 %). According to findings of computerized tomography, the majority of patients were classified as grade D and grade E. Ten patients (56%) had infected necrosis, where as eight patients (44%) had sterile necrosis at the time of surgery. Patients were selected on the basis of an admission Acute Physiology and Chronic Health Evaluation (APACHE) II score, The mean APACHE II was found 17. Eleven patients required single debridements, whereas seven required 2 to 5 debridements. The average intensive care stay and the average lenght of hospital stay was 11 and 23 days respectively. The most frequent complication was pancreatic fistula (33%). Development of pancreatic pseudocyst occurred in 3 patients. Overall mortality was 44%. In conclusion, there are numerous surgical options for the management of pancreatic necrosis, Surgical debridement should be undertaken as quickly as possible in infected necrosis. However, making decision to surgery on patients with sterile necrosis is difficult, Most patients with sterile necrosis respond to intensive care unit treatment. Despite intensive care support if patients deteriorate and organ failure develops surgical intervention will be inevitable.
Keywords: NECROTIZING PANCREATITIS, INFECTED NECROSIS, STERILE NECROSIS, NECROSECTOMY