[Early and prolonged peritoneal lavage with laparoscopy in severe acute pancreatitis]

Abstract

Objective: The evaluation of precocious and prolonged lavage and drainage by laparoscopic approach in the treatment of severe acute pancreatitis.

Material and method: This therapeutic prospective study was conducted during 01.01.2006-31.03.2008 on a sample consisting of 35 subjects with the severe acute pancreatitis has been divided into two lots. A lot is formed by 16 patients whom were applied the method mentioned ahead and in the B lot--19 patients, treated by conventional and known methods of treatment. The method proposed, completed about laparoscopic approach in a third day of admission, consists, after setting lesional balance, in lavage of peritoneal space and mounting two tubes drainage, one subhepatic space and the other in Douglas space. Post operator for 7 days performed peritoneal lavage discontinuous with physiological serum. For an accurate assessment may were determined serum and peritoneal concentrations of interleukin 6.

Results: The duration of organic disfunction was 8 days for A lot subjects and 17,7 days for B lot subjects. The complications occurred and the needs of surgical treatment was net disadvantage at the patients treated conventionally. The mortality at A lot was 12.5% (n=2) and at lot B 36.8% (n=7). The tardive mortality by sepsis was null at subjects with lavage and was 15,8% (n=3) at subjects without lavage. The precocious mortality was 12,5% (n=2) in the A lot and 21% (n=4) in the lot B. The average hospitalization was 25,8 days in subjects with peritoneal lavage and 35,8 days in those treated conservatively, the difference is statistically significant. The method has proved not generating of morbidity and supplementary mortality. Study of the variation of serum and peritoneal concentrations of interleukin 6 shows the modulator effect of the peritoneal lavage early and prolonged of the inflammatory response and offers an argument of the inefficiency of short peritoneal lavage.

Conclusions: The data obtained indicate early and extended peritoneal lavage by laparoscopic method as a useful therapy in the management of severe acute pancreatitis.