Planned Reoperative Necrosectomy/Debridement for Necrotizing Acute Pancreatitis with Delayed Primary Closure
作者:
Michael G. Sarr,
期刊:
Digestive Surgery
(Karger Available online 1994)
卷期:
Volume 11,
issue 3-6
页码: 252-256
ISSN:0253-4886
年代: 1994
DOI:10.1159/000172263
出版商: S. Karger AG
关键词: Necrotizing pancreatitis;Necrosectomy
数据来源: Karger
摘要:
Management of the peripancreatic bed after necrosectomy for surgical complications of acute necrotizing pancreatitis remains controversial. Since 1985, we have adopted a technique of planned, reoperative necrosectomy/debridement with eventual primary wound closure over peripancreatic drains. Using this approach in 47 patients, we have experienced an operative mortality of 23% and a recurrent intra-abdominal abscess rate of 13%, all but one of which were treated by simple percutaneous drainage. In contrast, 18 patients were managed by a single operative necrosectomy with placement of peripancreatic drains; their operative mortality was 33%, and all 3 patients who developed intra-abdominal abscesses required reoperation. We believe that a planned reoperative necrosectomy with eventual primary abdominal closure maximizes the success of complete necrosectomy and minimizes the incidence of recurrent (or persistent) intra-abdominal sepsis.
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