FASCIAL CLOSURE IN THE MANAGEMENT OF INFECTED PANCREATIC NECROSIS

Reports have focused on the perceived benefit of a new method of manag ing pancreatic necrosis and sepsis: leaving the abdomen packed open af ter debridement, the ''marsupialization'' technique. We have continued to treat infected pancreatic necrosis with aggressive pancreatic debr idement and drainage, closure of the abdomen, and prompt reoperation a s often as necessary if further sepsis is identified. We report 52 con secutive patients with infected pancreatic necrosis operated upon betw een July, 1972 and March, 1990. Postoperative organ failure and APACHE II scoring correlated with survival. Patients with APACHE II scores l ess than 15 had an operative mortality rate of 4 per cent, whereas pat ients with scores greater than 15 had a 44 per cent mortality rate. We recognize that no two retrospective series are truly comparable, but in comparison to published reports on the open technique, fascial clos ure after pancreatic debridement appeared to produce fewer wound compl ications (only one dehiscence and one incisional hernia) and fewer tri ps to the operating room.