OPEN VS CLOSED TREATMENT OF SECONDARY PANCREATIC INFECTIONS - A REVIEW OF 42 CASES

Objective: To compare the results of closed treatment (CT) with the re sults of open treatment (OT) that uses laparostomy and marsupializatio n of the lesser sac in patients affected by secondary pancreatic infec tions. Design: Retrospective cohort study. Setting: Both primary and r eferral hospital care. Patients: Forty-two patients undergoing emergen cy operations for unequivocal secondary pancreatic infections (infecte d pancreatic necrosis [n=26] and pancreatic abscess [n=14]) were retro spectively divided into two treatment groups on the basis of the opera tive treatment: conventional CT (n=24) (1981 through 1986) and OT by l aparostomy and marsupialization of the lesser sac (n=18) (1987 through 1991). The OT and CT groups were homogeneous regarding demographic ch aracteristics, mean APACHE (Acute Physiology and Chronic Health Evalua tion) II score (17.1 +/- 6.0 vs 17.9 +/- 7.2, respectively; P value wa s not significant), and distribution of patients according to the type of pancreatic infection (infected pancreatic necrosis [13 vs 15, resp ectively] and pancreatic abscess [five vs nine, respectively]). The us e of medical supportive care, including total parenteral nutrition and heavy doses of broad-spectrum antibiotics, was similar in both groups . Main Outcome Measures: Surgical complications; recurrent or persiste nt sepsis; postoperative death. Results: The incidence of major surgic al complications was 55.5% and 8.3% in OT and CT groups, respectively (P=.001). In OT and CT groups, signs of recurrent or persistent sepsis were observed in 5.6% vs 41.7% of the patients, respectively (P=.008) : 7.7% vs 46.7% in patients with infected pancreatic necrosis (P=.02) and 0% vs 33.3% in patients with pancreatic abscess (P value was not s ignificant). Overall mortality rates were 22.2% and 28.5% in the OT an d CT groups, respectively (P value was not significant). The mortality rates due to recurrent or persistent sepsis in the OT and CT groups w ere 5.5% and 29.1%, respectively (P=.03). Conclusions: Although the fr equency of major surgical complications after OT is significantly high er than that observed after CT, open drainage by means of laparostomy and marsupialization of the lesser sac controls pancreatic infection b etter, thus reducing mortality rate due to persistent or recurrent sep sis.