CHANGING STRATEGIES IN THE SURGICAL-MANAGEMENT OF ACUTE NECROTIZING PANCREATITIS

During 1982-90 we changed the surgical treatment of acute necrotizing pancreatitis twice. The operative strategy consisted of early formal r esection (n = 13) during 1982-84, early lavational surgery (n = 15) du ring 1985-87 and late necrosectomy (n = 17) during 1988-90. The mortal ity rate decreased from 54% to 40% and to 24%, respectively. The patte rn of complications changed from bleeding in resections to pseudocysts and fastulas in late necrosectomy. Sepsis and multiorgan failure were still main problems. These results led us to begin a prospective stud y of planned repeated debridement by open packing after delayed necros ectomy.