SURGERY FOR ACUTE NECROTIC PANCREATITIS - ACTIVE PROLONGED DRAINAGE IN 157 CONSECUTIVE CASES

Objectives: Conventional surgery and non-surgical methods have given u nsatisfactory results for the treatment of acute necrotic pancreatitis . We therefore adopted active prolonged drainage with the aim of contr olling both acute enzyme toxicity and secondary necrosis. Methods: One hundred fifty-seven patients with necrotic pancreatitis defined as th e presence of extensive pancreatic or peripancreatic necrosis at lapar otomy were divided into three groups according to previous care: group 1 no prior medical or surgical treatment (n = 46, 29%), group 2 prior medical but no surgical treatment (n = 48, 31%) and group 3 prior med ical and surgical treatment (n = 63, 40%). Spiral drains were placed i n the drainage grooves after necrosectomy and post-operative drainage with Mikulicz bags. Continuous lavage-drainage was then maintained for 45 days. Enteral nutrition was initiated on day 7 (mean) and increase d progressively to 75 kcal/kg/day so parenteral nutrition could be int errupted 8 days later. Results: There were 28 deaths (18%) including 6 in group 1, 10 in group 2 and 12 in group 3 (13, 21 and 19% respectiv ely). Deaths were due to early multiple organ failure (n = 16), progre ssive degradation of the clinical situation (n = 8) and sudden death d espite improvement (n = 4). Complications requiring re-operation occur red in 44 patients (28%). Among the 129 survivors, mean duration of ho spitalization was 70 days including 60 days in the intensive care unit .Conclusions: Compared with results from former series, active prolong ed drainage appears to be more adapted to the natural history and anat omic presentation of acute necrotic pancreatitis.