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
. 2020 Mar 17;15(1):21.
doi: 10.1186/s13017-020-00300-9.

Open necrosectomy in acute pancreatitis-obsolete or still useful?

Henrik Leonard Husu  1 , Jouni Antero Kuronen  2 , Ari Kalevi Leppäniemi  3 , Panu Juhani Mentula  3
Affiliations

Open necrosectomy in acute pancreatitis-obsolete or still useful?

Henrik Leonard Husu et al. World J Emerg Surg. .

Abstract

Background: Multiple organ failure and early surgery are associated with high morbimortality after open necrosectomy. Data are mostly derived from historical cohorts with early necrosectomy bereft of step-up treatment algorithm implementation. Thus, mostly circumstantial evidence suggests a better clinical course following mini-invasive surgical and endoscopic necrosectomy. We studied the results of open necrosectomy in a contemporary cohort of patients with complicated pancreatic necrosis treated at a tertiary center.

Methods: A retrospective cohort study from a university teaching hospital. Results of 109 consecutive patients treated with open necrosectomy during a 12-year period are reported.

Results: The overall 90-day mortality rate was 22.9%. The 90-day mortality rate was 10.6% if necrosectomy could be delayed until 4 weeks from symptom onset and the necrosis had become walled off on preoperative imaging. The risk factors for 90-day mortality were age over 60 years (OR 19.4), pre-existing co-morbidities (OR 16.9), necrosectomy within 4 weeks (OR 6.5), multiple organ failure (OR 12.2), white blood cell count over 23 × 109 (OR 21.4), and deterioration or prolonged organ failure as an indication for necrosectomy (OR 10.4). None or one of these risk factors was present in 52 patients (47.7% of all patients), and these patients had no mortality.

Conclusion: Late open necrosectomy for walled-off necrosis has a low mortality risk. Open necrosectomy can be done without mortality in the absence of multiple risk factors for surgery.

Keywords: Acute pancreatitis; Infected pancreatic necrosis; Mortality; Necrosectomy; Open necrosectomy; Organ failure; Pancreatic necrosis; Pancreatitis; Severe acute pancreatitis; Walled-off necrosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan-Meier 90-day survival table, walled-off necrosis vs. acute necrotic collections
See this image and copyright information in PMC

References

    1. Lankisch Paul Georg, Apte Minoti, Banks Peter A. Acute pancreatitis. The Lancet. 2015;386(9988):85–96. doi: 10.1016/S0140-6736(14)60649-8. - DOI - PubMed
    1. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–111. doi: 10.1136/gutjnl-2012-302779. - DOI - PubMed
    1. Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101(10):2379–2400. doi: 10.1111/j.1572-0241.2006.00856.x. - DOI - PubMed
    1. Petrov Maxim S., Shanbhag Satyanarayan, Chakraborty Mandira, Phillips Anthony R.J., Windsor John A. Organ Failure and Infection of Pancreatic Necrosis as Determinants of Mortality in Patients With Acute Pancreatitis. Gastroenterology. 2010;139(3):813–820. doi: 10.1053/j.gastro.2010.06.010. - DOI - PubMed
    1. van Santvoort HC, Bakker OJ, Bollen TL, Besselink MG, Ahmed Ali U, Schrijver AM, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology. 2011;141(4):1254–1263. doi: 10.1053/j.gastro.2011.06.073. - DOI - PubMed

Publication types