Surgical strategy and management of infected pancreatic necrosis
Infected pancreatic necrosis and sepsis are the leading causes of death in patients with necrotizing pancreatitis. Between 1986 and 1993, 123 patients with infected pancreatic necrosis were treated; in all cases the infected necrosis extended to the retroperitoneal area. Surgical treatment was perfo...
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| Veröffentlicht in: | British journal of surgery 1996-07, Vol.83 (7), p.930-933 |
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| creator | Farkas, G. Márton, J. Mándi, Y. Szederkényi, E. |
| description | Infected pancreatic necrosis and sepsis are the leading causes of death in patients with necrotizing pancreatitis. Between 1986 and 1993, 123 patients with infected pancreatic necrosis were treated; in all cases the infected necrosis extended to the retroperitoneal area. Surgical treatment was performed a mean of 18·5 days after the onset of acute pancreatitis. Operative management consisted of wide‐ranging necrosectomy through all the affected area, combined with continuous widespread lavage and suction drainage applied for a mean of 39·5 days, with a median of 6·5 litres of normal saline per day. In 56 cases (46 per cent), another surgical intervention (distal pancreatic resection, splenectomy, cholecystectomy, sphincteroplasty or colonic resection) was also performed. Bacteriological findings revealed mainly enteric bacteria, but Candida infection was detected in 21 per cent of patients. The overall hospital mortality rate was 7 per cent (nine patients died). Infected pancreatic necrosis responds well to aggressive surgical treatment, continuous, longstanding lavage and suction drainage, together with supportive therapy combined with adequate antibiotic and antifungal medication. |
| doi_str_mv | 10.1002/bjs.1800830714 |
| format | Article |
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Between 1986 and 1993, 123 patients with infected pancreatic necrosis were treated; in all cases the infected necrosis extended to the retroperitoneal area. Surgical treatment was performed a mean of 18·5 days after the onset of acute pancreatitis. Operative management consisted of wide‐ranging necrosectomy through all the affected area, combined with continuous widespread lavage and suction drainage applied for a mean of 39·5 days, with a median of 6·5 litres of normal saline per day. In 56 cases (46 per cent), another surgical intervention (distal pancreatic resection, splenectomy, cholecystectomy, sphincteroplasty or colonic resection) was also performed. Bacteriological findings revealed mainly enteric bacteria, but Candida infection was detected in 21 per cent of patients. The overall hospital mortality rate was 7 per cent (nine patients died). Infected pancreatic necrosis responds well to aggressive surgical treatment, continuous, longstanding lavage and suction drainage, together with supportive therapy combined with adequate antibiotic and antifungal medication.</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1002/bjs.1800830714</identifier><identifier>PMID: 8813777</identifier><identifier>CODEN: BJSUAM</identifier><language>eng</language><publisher>Bristol: John Wiley & Sons, Ltd</publisher><subject>Acute Disease ; Adult ; Aged ; Bacterial Infections - pathology ; Bacterial Infections - surgery ; Biological and medical sciences ; Drainage ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; Hospital Mortality ; Humans ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Male ; Medical sciences ; Middle Aged ; Necrosis - microbiology ; Necrosis - surgery ; Other diseases. 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Between 1986 and 1993, 123 patients with infected pancreatic necrosis were treated; in all cases the infected necrosis extended to the retroperitoneal area. Surgical treatment was performed a mean of 18·5 days after the onset of acute pancreatitis. Operative management consisted of wide‐ranging necrosectomy through all the affected area, combined with continuous widespread lavage and suction drainage applied for a mean of 39·5 days, with a median of 6·5 litres of normal saline per day. In 56 cases (46 per cent), another surgical intervention (distal pancreatic resection, splenectomy, cholecystectomy, sphincteroplasty or colonic resection) was also performed. Bacteriological findings revealed mainly enteric bacteria, but Candida infection was detected in 21 per cent of patients. The overall hospital mortality rate was 7 per cent (nine patients died). Infected pancreatic necrosis responds well to aggressive surgical treatment, continuous, longstanding lavage and suction drainage, together with supportive therapy combined with adequate antibiotic and antifungal medication.</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Aged</subject><subject>Bacterial Infections - pathology</subject><subject>Bacterial Infections - surgery</subject><subject>Biological and medical sciences</subject><subject>Drainage</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Necrosis - microbiology</subject><subject>Necrosis - surgery</subject><subject>Other diseases. Semiology</subject><subject>Pancreatitis - pathology</subject><subject>Pancreatitis - surgery</subject><subject>Postoperative Hemorrhage - etiology</subject><subject>Reoperation</subject><subject>Treatment Outcome</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1996</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkM1v1DAQxS0EKkvhyg0pB8Qt7djjr9yACgqlBcSCerQcZ7xySbKLnVXZ_56gXW1Po6f3eyO9x9hLDmccQJy3d-WMWwCLYLh8xBYctaoF1_YxWwCAqTkKfMqelXIHwBGUOGEn1nI0xizY2-U2r1LwfVWm7Cda7So_dtXgR7-igcapWscqjZHCRF218WPI5KcUqpFCXpdUnrMn0feFXhzuKfv18cPPi0_19bfLzxfvruugAGUttJJRalQqtiYaj7LTVqqIQjZeaOhsQIwNkg4adCOaFtAT5xSbBpRv8ZS92f_d5PWfLZXJDakE6ns_0npbnLEoBQcxg68O4LYdqHObnAafd-5QefZfH3xf5t4xz51SOWLIlZFCzVizx-5TT7ujzcH9n93Ns7uH2d37q-WDmrP1PpvKRH-PWZ9_O23QKHf79dL9uPly-13ZpeP4D-Nog7Y</recordid><startdate>199607</startdate><enddate>199607</enddate><creator>Farkas, G.</creator><creator>Márton, J.</creator><creator>Mándi, Y.</creator><creator>Szederkényi, E.</creator><general>John Wiley & Sons, Ltd</general><general>Wiley</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>199607</creationdate><title>Surgical strategy and management of infected pancreatic necrosis</title><author>Farkas, G. ; Márton, J. ; Mándi, Y. ; Szederkényi, E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5034-2654f46355fb7f7a34d6845f3249a260d8c33f93e6c606929b03ae11ef9905ab3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1996</creationdate><topic>Acute Disease</topic><topic>Adult</topic><topic>Aged</topic><topic>Bacterial Infections - pathology</topic><topic>Bacterial Infections - surgery</topic><topic>Biological and medical sciences</topic><topic>Drainage</topic><topic>Female</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Necrosis - microbiology</topic><topic>Necrosis - surgery</topic><topic>Other diseases. Semiology</topic><topic>Pancreatitis - pathology</topic><topic>Pancreatitis - surgery</topic><topic>Postoperative Hemorrhage - etiology</topic><topic>Reoperation</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Farkas, G.</creatorcontrib><creatorcontrib>Márton, J.</creatorcontrib><creatorcontrib>Mándi, Y.</creatorcontrib><creatorcontrib>Szederkényi, E.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Farkas, G.</au><au>Márton, J.</au><au>Mándi, Y.</au><au>Szederkényi, E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgical strategy and management of infected pancreatic necrosis</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>1996-07</date><risdate>1996</risdate><volume>83</volume><issue>7</issue><spage>930</spage><epage>933</epage><pages>930-933</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><coden>BJSUAM</coden><abstract>Infected pancreatic necrosis and sepsis are the leading causes of death in patients with necrotizing pancreatitis. Between 1986 and 1993, 123 patients with infected pancreatic necrosis were treated; in all cases the infected necrosis extended to the retroperitoneal area. Surgical treatment was performed a mean of 18·5 days after the onset of acute pancreatitis. Operative management consisted of wide‐ranging necrosectomy through all the affected area, combined with continuous widespread lavage and suction drainage applied for a mean of 39·5 days, with a median of 6·5 litres of normal saline per day. In 56 cases (46 per cent), another surgical intervention (distal pancreatic resection, splenectomy, cholecystectomy, sphincteroplasty or colonic resection) was also performed. Bacteriological findings revealed mainly enteric bacteria, but Candida infection was detected in 21 per cent of patients. The overall hospital mortality rate was 7 per cent (nine patients died). Infected pancreatic necrosis responds well to aggressive surgical treatment, continuous, longstanding lavage and suction drainage, together with supportive therapy combined with adequate antibiotic and antifungal medication.</abstract><cop>Bristol</cop><pub>John Wiley & Sons, Ltd</pub><pmid>8813777</pmid><doi>10.1002/bjs.1800830714</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | British journal of surgery, 1996-07, Vol.83 (7), p.930-933 |
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| source | Oxford University Press Journals All Titles (1996-Current); MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Acute Disease Adult Aged Bacterial Infections - pathology Bacterial Infections - surgery Biological and medical sciences Drainage Female Gastroenterology. Liver. Pancreas. Abdomen Hospital Mortality Humans Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical sciences Middle Aged Necrosis - microbiology Necrosis - surgery Other diseases. Semiology Pancreatitis - pathology Pancreatitis - surgery Postoperative Hemorrhage - etiology Reoperation Treatment Outcome |
| title | Surgical strategy and management of infected pancreatic necrosis |
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