Pancreatic Resection Versus Peritoneal Lavage in Acute Necrotizing Pancreatitis

Abstract

Twenty-one patients with acute fulminant alcoholic pancreatitis were randomly allocated to either pancreatic resection group (11 patients) or nonoperative peritoneal lavage group (10 patients). Only patients under 50 years were included in the study to minimize the role of other severe disease. These patients represented the most severe cases of acute pancreatitis at our Department, constituting only 2% of all patients with acute pancreatitis during this period. The diagnosis was based on clinical symptoms and on signs indicating severely impaired systemic organ functions. All patients underwent contrast-enhanced computed tomography (CT), which showed contrast enhancement below 30 Hounsfield units. In the operated cases, the diagnosis of necrotizing pancreatitis was verified histologically. All patients with conservative treatment had dark brown fluid at peritoneal puncture. There was a difference (nonsignificant) in mortality (3/11 and 1/10, respectively), complication rate, or in the need of reoperations between the groups. Nonoperative peritoneal lavage was followed with shorter treatment at the intensive care unit (16.2 versus 25.9 days, respectively). The hospital stay also was significantly shorter in the nonoperative group (44.3 versus 56.1 days). The results indicate that intensive conservative treatment is justified as an initial therapy even in the most severe cases of acute pancreatitis.

High-Dose intraperitoneal aprotinin treatment of acute severe pancreatitis: A double-blind randomized multi-center trial

“…l At the beginning of the 1970s, Ranson and colleagues found a mortality of 100% when a patient demonstrated 7 or more of their 11 prognostic signs during the initial 48 h.19'22 Today, a mortality of about 15% is reported in most studies of severe acute pancreatitis. [23][24][25] In the present study, with a median Ranson score of 4.1, the mortality was 16.6%. Death is caused by the failure of different organ systems.…”

Treatment of Acute Pancreatitis: An Attempted Historical Review

“…Eight randomized prospective clinical trials evaluating the influence of continuous peritoneal lavage in patients with acute pancreatitis were performed, but led to divergent results [38,39,40,41,42,43,44,45]. A meta-analysis, however, showed that this therapeutic procedure was not associated with any improvement in mortality or morbidity [46].…”

Severe acute pancreatitis: Case-oriented discussion of interdisciplinary management

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