Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2008 Feb;247(2):294-9.
doi: 10.1097/SLA.0b013e31815b6976.

Debridement and closed packing for sterile or infected necrotizing pancreatitis: insights into indications and outcomes in 167 patients

J Ruben Rodriguez  1 , A Oswaldo Razo, Javier Targarona, Sarah P Thayer, David W Rattner, Andrew L Warshaw, Carlos Fernández-del Castillo
Affiliations
Comparative Study

Debridement and closed packing for sterile or infected necrotizing pancreatitis: insights into indications and outcomes in 167 patients

J Ruben Rodriguez et al. Ann Surg. 2008 Feb.

Abstract

Objective: To examine the surgical indications and clinical outcomes of a large cohort of patients with necrotizing pancreatitis.

Summary background data: Mortality after debridement for necrotizing pancreatitis continues to be inordinately high. The clinical experience with patients who underwent uniform surgical treatment for necrotizing pancreatitis at the Massachusetts General Hospital over a 15-year period is described.

Methods: Retrospective review of 167 patients with necrotizing pancreatitis who required intervention and were treated with single stage debridement and a closed packing technique. Particular emphasis was placed on the indication for surgery and the presence of infected necrosis. Multiple logistic regression models were used to identify predictors of mortality.

Results: The primary preoperative indication for operation was infected necrosis (51%), but intraoperative cultures proved that 72% of the entire cohort was infected. The rate of reoperation was 12.6%, and 29.9% of patients required percutaneous interventional radiology drainage after initial debridement. Overall operative mortality was 11.4% (19/167), but higher in patients who were operated upon before 28 days (20.3% vs. 5.1%, P = 0.002). Other important predictors of mortality included organ failure > or =3 (OR = 2.4, P = 0.001), postoperative intensive care unit stay > or =6 days (OR = 15.9, P = 0.001), and female gender (OR = 5.41, P = 0.02).

Conclusions: Open, transperitoneal debridement followed by closed packing and drainage results in the lowest reported mortality and reoperation rates, and provides a standard for comparing other methods of treatment. A negative FNA does not reliably rule out infection. The clinical status of the patients and not proof of infection should determine the need for debridement.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
Etiology of pancreatitis in 167 patients with necrotizing pancreatitis requiring debridement.
FIGURE 2
FIGURE 2
Mortality as a function of pre-operative organ failure in 167 patients.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Beger HG, Rau B, Isenmann R. Natural history of necrotizing pancreatitis. Pancreatology. 2003;3:93–101. - PubMed
    1. Bradley EL, III, Allen K. A prospective longitudinal study of observation versus surgical intervention in the management of necrotizing pancreatitis. Am J Surg. 1991;161:19–24. discussion-5. - PubMed
    1. Buchler MW, Gloor B, Muller CA, et al. Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg. 2000;232:619– 626. - PMC - PubMed
    1. Whitcomb DC. Clinical practice. Acute pancreatitis. N Engl J Med. 2006;354:2142–2150. - PubMed
    1. Connor S, Alexakis N, Raraty MG, et al. Early and late complications after pancreatic necrosectomy. Surgery. 2005;137:499–505. - PubMed

Publication types

MeSH terms