Details

Autor(en) / Beteiligte

• Kasperk, R
• Riesener, K P
• Schumpelick, V

Titel

Surgical therapy of severe acute pancreatitis: a flexible approach gives excellent results

Ist Teil von

• Hepato-gastroenterology, 1999-01, Vol.46 (25), p.467

Ort / Verlag

Greece

Erscheinungsjahr

1999

Quelle

MEDLINE

Beschreibungen/Notizen

• To evaluate the effectiveness of our surgical strategy in acute and necrotizing pancreatitis we performed this prospective uncontrolled study. Seventy-six patients with severe acute pancreatitis who were operated on between 1989 and 1995 were included in this study. Laparotomy aimed at removal of necrosis, treatment of ongoing necrosis, and correction of concurrent pathology were the principal goals of surgery. This required multiple interventions in 36 patients. Sixty-nine patients with a mean Ranson score of 3 survived, while 7 patients with a mean score of 7 died (9.2% overall mortality). Fifty-six patients (74%) underwent necrosectomy, followed by continuous lavage in 31 cases and laparostomy (provisional closure of abdominal cavity with absorbable mesh) with staged revisions in 14. Necroses were infected in 39% of initial operations. Twenty-two patients had to be re-operated without being scheduled for planned revisions, mostly for abscess formation, bleeding or intestinal ischemia. Mortality of necrotizing pancreatitis was 12.5%. Surgical therapy of acute necrotizing pancreatitis has to be tailored to the intra- and post-operative situations. In cases of massive or ongoing necrosis, the goal of surgical therapy will not be achieved by a singular intervention but has to be complemented with further treatment.