World Journal of Surgery

, Volume 36, Issue 5, pp 1142–1147

Treatment of Necrotizing Pancreatitis: Redefining the Role of Surgery

  • Guido Alsfasser
  • Frank Schwandner
  • Annette Pertschy
  • Karlheinz Hauenstein
  • Thomas Foitzik
  • Ernst Klar
Article
  • 539 Downloads

Abstract

Background

Early surgical intervention in necrotizing pancreatitis (NP) is associated with high mortality. Guidelines recommend fine needle aspiration (FNA) in patients with NP and signs of sepsis. Because infection of necrosis is considered an indication for surgery, operations are often performed early. We changed treatment toward a conservative approach with FNA in selected cases only, thereby reducing the rate of necrosectomy.

Methods

Retrospectively analyzed patients, all operated on for FNA-proven infection of pancreatic necrosis (n = 20, group 1) were compared to patients subjected to conservative treatment (n = 24, group 2) who were followed prospectively.

Results

Prognostic scores did not differ between the two groups, indicating comparable severity: the Acute Physiology and Chronic Health Evaluation (APACHE II) score was 19.8 ± 1.7 versus 16 ± 2.2; the Sequential Organ Failure Assessment (SOFA) score was 8.7 ± 1.4 versus 6.9 ± 1.0, the C-reactive protein (CRP) level on day 3 was 243 ± 21 versus 291 ± 21, and the CTSI (CT severity index) was 7.8 ± 0.5 versus 7.9 ± 0.4 (p = ns). Ten patients in group 2 underwent operation because of severe extrapancreatic complications. Mortality differed significantly (45% in group 1 vs. 8.3% in group 2; p = 0.01).

Conclusions

A highly conservative approach avoiding open necrosectomy in NP results in significantly lower mortality than previous serial FNA and consecutive indication for surgery in case of proven infection. Open surgery in NP should be reserved for concomitant intra-abdominal complications.

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Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Guido Alsfasser
    • 1
  • Frank Schwandner
    • 1
  • Annette Pertschy
    • 1
  • Karlheinz Hauenstein
    • 2
  • Thomas Foitzik
    • 1
  • Ernst Klar
    • 1
  1. 1.Department of General, Thoracic, Vascular and Transplantation SurgeryUniversity of RostockRostockGermany
  2. 2.Department of RadiologyUniversity of RostockRostockGermany

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