Progress in the management and treatment of infected pancreatic necrosis

Infected pancreatic necrosis and sepsis are the leading causes of mortality in necrotizing pancreatitis. A review has been undertaken of the results o f the past two decades relating to different surgical treatments of infecte d pancreatic necrosis. During the period 1978-85, the surgical treatment of necrotizing pancreatitis and its complications in our department consisted of the 'conventional' therapy (resection of the involved pancreatic tissue , or necrosectomy and drainage) in 61 patients, with a mortality rate of 36 % (22 patients died). Since 1986, we have performed necrosectomy and other surgical interventions combined with continuous widespread lavage in 142 pa tients with infected pancreatic necrosis. The overall mortality decreased s ignificantly to 6.3% (9 patients died). This result was achieved by means o f aggressive surgical treatment, continuous, prolonged washing and suction drainage and supportive therapy, including immunonutrition, modifying the c ytokine production and adequate antibiotic and antifungal medication. This surgical strategy provides the possibility for recovery in cases of necroti zing pancreatitis with septic complications.