MANAGEMENT OF NECROTIZING PANCREATITIS BY REPEATED OPERATIVE NECROSECTOMY USING A ZIPPER TECHNIQUE

METHODS: From 1983 to 1995, 72 patients with necrotizing pancreatitis were treated with a general approach involving planned reoperative nec rosectomies and interval abdominal wound closure using a zipper. RESUL TS: Hospital mortality was 25%. Multiple organ failure without sepsis caused early mortality in 3 of 4 patients and sepsis caused late morta lity in 11 of the remaining 14. The mean number of reoperative necrose ctomies/debridements was 2 (0 to 7). Fistulae developed in 25 patients (35%); 64% were treated conservatively. Recurrent intraabdominal absc esses developed in 9 patients (13%) but were drained percutaneously in 5. Hemorrhage required intervention in 13 patients (18%). Prognostic factors included APACHE-II score on admission <13 (P = 0.005), absence of postoperative hemorrhage (P = 0.01), and peripancreatic tissue nec rosis alone (P < 0.05). CONCLUSIONS: The zipper approach effectively m aximizes the necrosectomy and decreases the incidence of recurrent int raabdominal infection requiring reoperation. APACHE-II score greater t han or equal to 13, extensive parenchymal necrosis, and postoperative hemorrhage signify worse outcome. (C) 1998 by Excerpta Medica, Inc.