Reoperation for severe pancreatitis - A 10-year experience in a tertiary care center

Objectives: To analyze the specific problems encountered in treating patien ts previously operated on for necrotizing pancreatitis and to determine the benefit of such a complex and demanding procedure. Design and Setting: Review of a case series in an academic tertiary care re ferral center. Patients: Forty-four consecutive patients referred and reoperated on in 10 years. Interventions: Reiterative laparotomy with complete debridment of all necro tic sites, followed by Mikulicz packing. Mikulicz packs were replaced by re movable drains allowing both local prolonged lavage and open drainage of la rge solid necrotic debris. Enteral nutrition was performed through a feedin g jejunostomy. Associated gastrointestinal tract lesions were simultaneousl y treated. Main Outcome Measures: Operative findings, bacteriological status of necros is, in-hospital mortality, length of hospitalization, and surgical complica tions and their management. Results: Necrosis was infected in 36 (82%) of the 44 cases and associated g astrointestinal tract lesions were found in 20 (45%) of these patients. Mor tality was 23%, and was significantly (P=.03) related to the preoperative c linical status. Surgical complications occurred in 31 (70%) of the 44 patie nts necessitating surgical treatment in 18 (41%;) of these patients. Mean ( +/-SD) stay in the intensive care unit was 44+/-8 days for survivors. Conclusion: This complex and demanding surgical procedure is worthwhile, yi elding mortality rates comparable to those observed in de novo severe necro tizing pancreatitis.