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BACKGROUND:The aim of this study was to evaluate the risk factors for morbidity in cases of walled-off pancreatic necrosis (WOPN) and the performance of continuous postoperative lavage (CPL) for patients who demonstrated resistance to a minimally invasive approach. METHODS:The study enrolled 19 of 28 consecutive patients with WOPN who underwent surgical treatment or an endoscopic necrosectomy at Sakarya University Education and Research Hospital. The patients were divided into 2 groups according to the length of time from the first diagnosis of acute pancreatitis (AP) (Group 1, n=19) to preoperation or endoscopic necrosectomy (Group 2) (n=19). All of the cases were retrospectively evaluated and compared in terms of demographic features, operative features, and complications. RESULTS:No statistically significant difference was found between the number of complications or the duration of hospital stay in terms of age, body mass index, size of the walled-off pancreatic necrosis, American Society of Anesthesiologists score, Ranson's criteria, operation time, and duration from AP to endoscopic necrosectomy or operation (p>0.05). Performance of an endoscopic necrosectomy was determined to be correlated with a decrease in the number of complications (B=-0.626, 95% confidence interval [CI]: -0.956 to -0.296; p<0.001), and when a high neutrophil-to-lymphocyte ratio (NLR) was detected at first admission, the number of complications was greater (B=0.032, 95% CI: 0.009-0.055; p=0.01). Reproduction in a culture and male gender were found to be risk factors for a prolonged hospital stay (B=0.669, 95% CI: 0.365-0.973; p<0.001), (B=0.484, 95% CI: 0.190-0.778; p=0.003), respectively. CONCLUSION: CPL is a safe and effective surgical treatment approach for WOPN. Reproduction in a culture, male gender, and a high NLR on first admission and a negative or not-available endoscopic necrosectomy were determined to be risk factors for a poor prognosis.

Stone extraction is difficult in patients with NAS and requires a greater number of ERCP sessions. The treatment of biliary stones proximal to an AS in patients with DDLT or LRLT is possible in most cases.