Surgical approach in acute necrotising pancreatitis

Acute necrotising pancreatitis is a dramatic and often life-threatening disease with a high rate of mortality, varying between 30-70% and necessitating heavy medical care. The surgical attitude regarding acute necrotising pancreatitis is disputed between the supporters of drainage with closed abdomen and the supporters of laparatomy with open drainage. The goal of this study is the evaluation of the number of intervention required, the timing of the interventions and the mortality and morbidity in a group of patients with necrotising pancreatitis. The studied group consists in 112 patients with necrotising pancreatitis, treated in Surgical Clinic of Caritas "Prof. Dr. N. Cajal" Clinical Hospital, Bucharest during 1983-2005. Infection of pancreatic necrosis supervened in 55,35% of patients in this group, not any pancreatic necrosis becomes infected. Infected necrosis is not synonymous for abscessed of necrosis, in the same patient pancreatic necrosis, infected pancreatic necrosis and abscessed necrosis may coexist. Clinical and biological criteria are the decisive factors in the indication for surgical treatment, the radiology being decisive in the choice of the laparotomy approach. In the study group 50,89% of patients necessitated only one surgical intervention. Implicitly, more than half of the patients would have been suffered multiple useless planned staged relaparotomies. The mortality in our study group treated by the method of closed drainage was 25,89%.