Skip to main content
  • 1132 Accesses


As discussed by Drs. Mantke and Lippert, the management of severe acute pancreatitis has changed markedly over the last several decades as we have come to understand more about the development and progression of necrotizing pancreatitis. Probably the biggest change/advance has been the move from an initial early and aggressive operative intervention/necrosectomy (Beger et al. 1982; Farrugia et al. 1993) to one of a more supportive, observational attempt at avoiding, if possible, any operative or interventional procedure in patients with sterile necrosis and delaying the timing of operative intervention to 3–4 weeks after onset of the disease, even in those with infected necrosis (Kendrick and Sarr 2005). This latter approach involves the use of targeted antibiotic treatment in patients with documented infected necrosis to prevent the systemic bacteremia and overwhelming sepsis and thereby to allow the local area(s) of infected necrosis to become “walled off” by the host response. By doing so, the eventual operative approach allows again a targeted necrosectomy in a contained area with much less postoperative morbidity and mortality. In addition, some patients avoid any operative or even radiologic intervention, because the disease process resolves spontaneously; how often such a phenomenon occurs, however, is unknown despite anecdotal reported experience (Runzi et al. 2005; Garg et al. 2010; Sarr and Seewald 2010).

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others


  • Beger HG, Block S, Krautzberger W et al (1982) Necrotizing pancreatitis. Surgical indications and results in 118 patients. Chirurg 53:784–789

    PubMed  CAS  Google Scholar 

  • Beger HG, Buchler M, Bittner R et al (1988) Necrosectomy and postoperative local lavage in necrotizing pancreatitis. Br J Surg 75:207–212

    Article  PubMed  CAS  Google Scholar 

  • Davidson ED, Bradley EL III (1981) “Marsupialization” in the treatment of pancreatic abscess. Surgery 89:252–256

    PubMed  CAS  Google Scholar 

  • Dellinger EP, Tellado JM, Soto NE et al (2007) Early antibiotic treatment for severe acute necrotizing pancreatitis: a randomized, double-blind, placebo-controlled study. Ann Surg 245:674–683

    Article  PubMed  Google Scholar 

  • Farrugia G, Rae JL, Sarr MG, Szurszewski JH (1993) Activation of a potassium current in human circular smooth muscle cells by carbon monoxide. Biophys J 64:A387

    Google Scholar 

  • Garg PK, Sharma M, Mandank K et al (2010) Primary conservative treatment results in mortality comparable to surgery in patients with infected necrosis. Clin Gastroenterol Hepatol 8(12):1089–1094

    Article  PubMed  Google Scholar 

  • Grewe M, Tsiotos GG, Luque-de Leon E, Sarr MG (1999) Fungal infection in acute necrotizing pancreatitis. J Am Coll Surg 188:408–414

    Article  PubMed  CAS  Google Scholar 

  • Horvath KD, Kao LS, Wherry KL et al (2001) A technique for laparoscopic-assisted percutaneous drainage of infected pancreatic necrosis and pancreatic abscess. Surg Endosc 15:1221–1225

    Article  PubMed  CAS  Google Scholar 

  • Isenmann R, Runzi M, Kron M et al (2004) Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled double-blind trial. Gastroenterology 126:997–1004

    Article  PubMed  CAS  Google Scholar 

  • Kendrick ML, Sarr MG (2005) Pancreatic necrosis and infections in patients with acute pancreatitis. In: Forsmark CE (ed) Pancreatitis and complications. Humana Press, Inc., Totowa, pp 99–112

    Chapter  Google Scholar 

  • Papachristou GI, Takahashi N, Chahal P, Sarr MG, Baron TH (2007) Peroral endoscopic drainage/debridement of walled-off pancreatic necrosis. Ann Surg 245:943–951

    Article  PubMed  Google Scholar 

  • Runzi M, Niebel W, Goebell H et al (2005) Severe acute pancreatitis: nonsurgical treatment of infected necroses. Pancreas 30:195–199

    Article  PubMed  Google Scholar 

  • Sakorafas GH, Tsiotos GG, Sarr MG (1999) Extrapancreatic necrotizing pancreatitis with viable pancreas: a previously under appreciated entity. J Am Coll Surg 188:643–648

    Article  PubMed  CAS  Google Scholar 

  • Sarr MG (1999) Appropriate use, complications and advantages demonstrated in 500 consecutive needle catheter jejunostomies. Br J Surg 86:557–561

    Article  PubMed  CAS  Google Scholar 

  • Sarr MG, Seewald S (2010) Do all patients with documented infected necrosis require necrosectomy/drainage? Clin Gastroenterol Hepatol 8(12):1000–1001

    Article  PubMed  Google Scholar 

  • Tsiotos GG, Luque-de Leon E, Soreide JA et al (1998) Management of necrotizing pancreatitis by repeated operative necrosectomy using a Zipper technique. Am J Surg 175:91–98

    Article  PubMed  CAS  Google Scholar 

  • van Santvoort HC, Besselink MG, Bakker OJ et al (2010) A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 362:1491–1502

    Article  PubMed  Google Scholar 

  • Warshaw AL, Gongliang J (1985) Improved survival in 45 patients with pancreatic abscess. Ann Surg 202:408–415

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Michael G. Sarr M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Sarr, M.G. (2013). Commentary. In: Mantke, R., Lippert, H., Büchler, M., Sarr, M. (eds) International Practices in Pancreatic Surgery. Springer, Berlin, Heidelberg.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-74505-1

  • Online ISBN: 978-3-540-74506-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics