Long-term outcome of necrotizing pancreatitis treated by necrosectomy

Background Long-term functional outcome after operative treatment of necrot izing pancreatitis (NP) has not been studied extensively. Methods Pancreatic function, performance status, recurrence of symptoms and other related problems were analysed in 44 consecutive patients successful ly discharged from hospital after operative necrosectomy (1983-1995) and fo llowed up completely for a mean of 5 years. Results Clinical pancreatic insufficiency developed in half the patients. D iabetes mellitus (11 patients), steatorrhoea (six) or both (five) were asso ciated with a mean estimate of 52, 66 and 67 per cent parenchymal necrosis respectively. Normal pancreatic function was associated with 27 per cent pa renchymal necrosis (P<0.05). Diabetes worsened while steatorrhoea tended to improve over time. Abdominal pain and pancreatitis recurred in six and two patients respectively. Performance status worsened in four patients becaus e of recurrent pancreatitis and severe steatorrhoea. Poor long-term perform ance was associated with a higher Acute Physiology And Chronic Health Evalu ation II score on admission (mean 14 versus 9). Conclusion NP has prominent effects on long-term pancreatic exocrine and en docrine function in half the patients, but most preserve a good overall fun ctional status. The development of pancreatic insufficiency varies with the extent of pancreatic parenchymal necrosis.