THE UTILITY OF POLYGLYCOLIC ACID MESH FOR ABDOMINAL ACCESS IN PATIENTS WITH NECROTIZING PANCREATITIS

Background: Necrotizing pancreatitis is a poorly understood process th at has been treated by a variety of surgical approaches. Despite advan ces in operative interventions and critical care, this disease often r equires prolonged resource allocation and continues to cause substanti al morbidity, with mortality rates ranging from 11% to 40%. We report on our recent series of patients with necrotizing pancreatitis and our experience with the use of an absorbable mesh in a subset of these pa tients to facilitate their surgical care. Study Design: From 1985 to 1 994, 40 patients with culture-proved necrotizing pancreatitis underwen t operative debridement and drainage. Surgical outcomes were compared among patients who underwent a single debridement and drainage, those requiring multiple procedures, and those having placement of polyglyco lic acid mesh. Results: The overall hospital mortality rate was 30%. T he mean length of hospital stay was 35 days. The rate of infected panc reatic necrosis was 60%, with a mortality rate of 45% in patients havi ng infected pancreatic tissue at surgery. Patients without infected pa ncreatic tissue at surgery had a mortality rate of 6% (p = 0.03). Elev en patients requiring multiple operations had placement of absorbable polyglycolic acid mesh. Clinic followup was possible in five of six su rvivors who underwent mesh closure. Abdominal-wall hernias developed i n two patients and were repaired electively, and three patients had sp ontaneous closure by granulation without abdominal-wall hernias. The a verage number of operations for debridement and drainage was 2.5 (rang e, 1-15). Patients with limited pancreatic necrosis required a single operative debridement and drainage, and this was associated with impro ved outcomes. Conclusions: Necrotizing pancreatitis remains an importa nt challenge in surgical care. It requires prolonged hospitalization, costly resources, and causes substantial morbidity and mortality. Our patients with infected pancreatic necrosis or clinical deterioration u nderwent open staged necrosectomy and debridement. Those patients requ iring repeat laparotomy often had placement of polyglycolic acid mesh. This provided open drainage of the abdominal cavity and simplified fu rther care by allowing easy abdominal access for repeat drainage proce dures, often performed in the intensive care unit. These patients had a high rate of fistula formation, which may be decreased by changes in wound care. Polyglycolic acid mesh is a useful adjunct in the surgica l care of selected patients with necrotizing pancreatitis. (C) 1998 by the American College of Surgeons.