Necrosectomy and postoperative local lavage in necrotizing pancreatitis

Abstract

Necrosectomy with postoperative continuous local lavage was performed in a prospective study involving 95 patients with necrotizing pancreatitis. In the same period 567 patients with oedematous-interstitial pancreatitis were treated non-operatively with a hospital mortality rate of 0.7 per cent. In patients with necrotizing pancreatitis the median Ranson criteria score was 4.5 points; operation was required at a median of 7 days after the onset of symptoms because of non-response to conservative treatment. In all, 59 per cent of the patients (56 out of 95) developed extended intrapancreatic parenchymal necrosis, 70 per cent had ascites, and 66 per cent had intra- and extrapancreatic necrosis; 42 per cent of the patients had bacterial infection of the necrotic tissue. For lavage a median of 8 l/24 h of fluid were instilled postoperatively for 25 days (median). The lavage fluid showed high levels of immunoreactive trypsin, phospholipase A2, and endotoxin in the early postoperative period. Hospital mortality rate was 8.4 per cent. Necrosectomy and continuous postoperative lavage can achieve high survival rates in patients with necrotizing pancreatitis. Postoperative local lavage allows the continuous non-operative evacuation of biologically active compounds and devitalized tissue, and avoids damage to remaining vital exocrine and endocrine pancreatic tissue.

Partial Pancreatectomy With Splenectomy Is the Best Option of Treatment for Infected Acute Necrotising Pancreatitis: A Prospective Study

“…29 Excellent results have been obtained with debridement and closed packing 22 debridement and local lavage 20,30 and debridement with open drainage. 31 A review of the literature performed by D'Egidio and Schein 32 found mortality rates of 36%, 23% and 25% respectively for the above three techniques.…”

“…However, they do represent a consecutive series of patients managed in a specific and consistent way. Continuous postoperative lavage as opposed to open packing has been demonstrated to allow safe evacuation of devitalised tissues without the need for routine reoperation 30 with minimal risk of gastrointestinal fistula formation or postoperative haemorrhage. 32,37 The authors are aware of the recognised risks following splenectomy, 38,39 but feels this to be small compared with the advantages to be gained from a more complete one-off debridement set against the background of a condition with at least 20% mortality.…”

Acute Severe Necrotising Pancreatitis Is Really a Surgical Challenge: An Overview

“…This procedure is recommended for all patients with necrotising pancreatitis in whom the systemic inflammatory response syndrome persists beyond the first week after onset of symptoms. 73 Aggressive pancreatic debridement (Necrosectomy) remains the standard surgical procedure, 74,75 and may require multiple abdominal explorations. This removes the infective necrotic tissue that drives the systemic inflammatory response leading to multiple organ failure.…”

Quando e como tratar as complicações na necrose pancreática infectada

“…Among them, debridement with external drainage, associated with postoperative peritoneal lavage and the program scheduled for reoperation, either closing the cavity or using the laparostomy 7,9,10,11,17,33,51,52,54,57,60 .…”

“…Thus, methods of percutaneous drainage guided by ultrasound or by CT have been used with satisfactory resolution rates and in a few days after surgery 9,19,23,31,34,60 .…”