SURGICAL ASPECTS AND MANAGEMENT OF ACUTE NECROTIZING PANCREATITIS - RECENT RESULTS OF A COOPERATIVE NATIONAL SURVEY IN JAPAN

A cooperative national survey between 1991 and 1994 recently clarified the status of acute necrotizing pancreatitis in Japan. The overall mo rtality rate was 20.8%; however, the mortality rate in patients with i nfection was 33.3%, and the mortality rate in patients who underwent s urgery was 27.4%. With regard to surgical procedures, drainage procedu res (mobilization of the pancreatic bed and retroperitoneal drainage) were performed most frequently, and one third of the patients who unde rwent drainage procedures needed reoperation. Although debridement of the necrotic tissue (necrosectomy or resection of the pancreas) was pe rformed in 33.3%, the mortality rate was 35.3%. There was no differenc e in the mortality rate between early and delayed operation. Recently two new modalities have been advocated for the management of severe ac ute pancreatitis in Japan. One is continuous regional arterial infusio n of protease inhibitor and antibiotics, and the other is continuous h emodiafiltration. Further work is needed to establish the most effecti ve procedures for the management of acute necrotizing pancreatitis and debridement of pancreatic infection.