Postoperative lavage and on demand surgical intervention in the treatment of acute necrotizing pancreatitis

Objective: to analyse our experience with a combined approach of postoperat ive local lavage and on demand surgical intervention in the treatment of ac ute necrotizing pancreatitis. Patients and methods: all patients operated on for acute pancreatitis in a tertiary hospital between June 1993 and July 1997 were studied retrospectiv ely. Demographic data, Ranson score, APACHE II score at admission were reco rded. Hospital charts and clinical courses were reviewed, Results: Seventeen patients were treated surgically because of end stage mu ltiple organ failure (MOF) (n = 13) or infected necrosis (n = 4). APACHE II and Ranson scores were 26,2 +/- 9,25 and 7,33 +/- 1,35 respectively. All p atients had protracted clinical courses, and required aggressive intensive care therapy. Forty-eight surgical interventions were performed in 17 patie nts. Early mortality was 36 percent. Complications were numerous, and mostl y consisted of intra-abdominal abscesses. Young age (under 55) was associat ed with significantly better outcome (22% vs. 87% mortality, p = 0,015) Conclusion: Continuous local lavage after surgical debridement, with on dem and re-laparotomy, proves to be a valuable approach in patients with necrot izing pancreatitis with acceptable morbidity and mortality rates. It appear s however, that the role of surgery for acute pancreatitis is limited to pa tients with infected necrosis or end stage MOF.