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Open Pancreatic Necrosectomy in the Multidisciplinary Management of Postinflammatory Necrosis

Babu, Benoy I. MRCS*; Sheen, Aali J. MD, FRCS*; Lee, Stephen H. FRCR; O'Shea, Sarah FRCR; Eddleston, Jane M. FRCA; Siriwardena, Ajith K. MD, FRCS*

doi: 10.1097/SLA.0b013e3181b59303

Objective: To examine clinical outcome in a consecutive cohort of patients undergoing open necrosectomy for postinflammatory necrosis.

Background Information: The last decade has witnessed major developments in the surgical management of pancreatic necrosis. Minimally invasive approaches have become established. However, there are limited data from contemporary open necrosectomy, in particular where multidisciplinary care and aggressive interventional radiology are used. This report provides data on outcome from open necrosectomy in a tertiary referral Hepatobiliary unit over the last decade.

Methods: During the period January 1, 2000 to July 31, 2008, 1535 patients were admitted with a final discharge code of acute pancreatitis. Twenty-eight (1.8%) of all admissions underwent open surgical necrosectomy. Twenty-four (86%) were tertiary referral patients.

Results: The median APACHE II score on admission was 10.5 (5–26). Median logistic organ dysfunction score on admission was 3 (0–10). Median LODS score after surgery was 2 (0–8). Twenty patients (71%) underwent radiologically guided drainage of collections before surgery. Thirty-day mortality occurred in 2 (7%), 4 further deaths occurred in patients after discharge from intensive care resulting in a total of 6 (22%) episode-related deaths.

Conclusions: Modern open necrosectomy can be performed without the procedure-related deterioration in organ dysfunction associated with major debridement. Multidisciplinary care with an emphasis on aggressive radiologic intervention before and after surgery results in acceptable outcomes in this cohort of critically ill patients. Newer laparoscopic techniques must demonstrate similar outcomes in the setting of stage-matched severity before wider acceptance.

Twenty-eight patients underwent open pancreatic necrosectomy in a tertiary referral Hepatobiliary unit over the last decade. Median logistic organ dysfunction score on admission to critical care was 3 (0–10). Median LODS after surgery was 2 (0–8). Overall episode-related mortality was 22% (6 deaths). Modern open necrosectomy can be performed without procedure-related deterioration in organ dysfunction.

From the *Hepatobiliary Surgical Unit, †Department of Radiology, and ‡Critical Care Unit, Manchester Royal Infirmary, Manchester, United Kingdom.

The authors did not receive any financial support.

Reprints: Ajith K. Siriwardena, MD, FRCS, HPB Unit, Department of Surgery, Manchester Royal Infirmary, Oxford Rd, Manchester M13 9WL, United Kingdom. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.