PRIMARY OPEN THERAPY FOR ACUTE NECROTIZING PANCREATITIS THROUGH OPEN-PACKING LAPAROSTOMY

There is no agreement about a conservative surgical strategy in the th erapy of acute necrotizing pancreatitis yet. This report describes our experience with "open packing" laparostomy. This procedure is only pe rformed when renal and pulmonary insufficiency is proceeding, despite optimal conservative treatment. Since 1986 15 patients were treated in this manner. Three compartments are established: an upper compartment (stomach, liver, spleen - covered by the omentum majus, which is diss ected from the colon transversum); a lower compartment (small bowel - covered by the left colon) and the mid compartment that permanently op ens the bursa omentalis and the left retrocolic space. Initially a car eful necrosectomy is performed. followed by a tamponade. At the intens ive care unit changing of the tamponade and lavage of the bursa omenta lis was done every day. So far two patients have died pursuing this th erapeutic regimen.