Parenchymal necrosis: infection and other indications for debridement and drainage

In the present review we describe our experience with debridement in necrot izing pancreatitis, with particular emphasis on the indications for surgery and the outcome in patients with infected and sterile necrosis. Within 7 y ears 64 patients with necrotizing pancreatitis underwent surgery with a med ian preoperative APACHE II score of 9. The indications for surgery were eit her proven infection or persistence of symptoms. Thirty-six patients were f ound to have infected necrosis, while 28 patients had sterile necrosis. The re was no significant difference between the two groups regarding pre- and postoperative parameters. The surgical technique involved a blunt necrosect omy followed by closed packing with Penrose drains. This technique produced the lowest reported mortality of 6.2 % with a reoperation rate of only 17 %, demonstrating that even with sterile necrosis surgical management can be carried out safely.