INFECTED PANCREATIC NECROSIS COMPLICATED BY MULTIPLE ORGAN FAILURE - PROSPECTIVE-STUDY OF SEQUENTIAL TREATMENT WITH ABDOMINAL TREATMENT WITH ABDOMINAL RE-EXPLORATION OPEN ABDOMEN AND CONTINUES CLOSED LAVAGE

Background/Aims: Sixteen patients with bacteriologically proven severe infected pancreatic necrosis (IPN) undergoing sequential surgical tre atment were studied prospectively. Methodology: The severity of IPN wa s documented pre-operatively using the following scores: 2) degree of necrosis by CT scan [<30% in three patients (19%); 30-50% in nine pati ents (56%); >50% in four patients (25%)]; 2) Elebute and Stoner's seps is score (16+/-4 points); 3) Goris' score of multiple organ failure (M OF) (5+/-2 points). Sequential surgical treatment was carr ied out by the same surgical team, as follows: 1) abdominal re-explorations throu gh a zipper for the first 7-10 days; 2) open abdomen and repeated peri toneal debridements for the following 7-10 days; 3) continuous closed peritoneal lavage with multiple drainage, until resolution of infectio n (range: 15-85 days). No patient required further re-exploration. Res ults: Mortality occurred in 3/16 patients (19%), due to MOF in all 3 c ases. The 13 survivors (81%) were discharged convalescent with closed abdominal wound, feeding orally, after 73+/-33 days, without fistulae. These results indicate that by treating severe IPN with the technique of sequential abdominal reexplorations, open, drainage and continuous closed lavage, a lore 19% mortality can be achieved. Conclusion: This study provides an assessment of the pre-operative severity of sepsis and of MOF in each patient with IPN these data could facilitate future comparison of results obtained with other treatment modalities.