Closed lesser sac lavage in the management of pancreatic necrosis

Background and Aim:  Surgery for pancreatic necrosis complicating acute severe pancreatitis carries a high risk of morbidity and mortality. We evaluated the efficacy of necrosectomy and closed lesser sac lavage as a method of management of pancreatic necrosis. Methods:  Fifty‐eight patients with pan...

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Bibliographic Details
Published in:Journal of gastroenterology and hepatology 2004-09, Vol.19 (9), p.1010-1015
Main Authors: WIG, JAI DEV, METTU, SRINIVAS REDDY, JINDAL, RAVUL, GUPTA, RAJESH, YADAV, THAKUR DEEN
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
closed lesser sac lavage
Female
Gastroenterology. Liver. Pancreas. Abdomen
Humans
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Male
Medical sciences
Middle Aged
necrosectomy
necrotizing pancreatitis
Other diseases. Semiology
Pancreas - pathology
Pancreas - surgery
pancreatic necrosis
Pancreatitis, Acute Necrotizing - etiology
Pancreatitis, Acute Necrotizing - mortality
Pancreatitis, Acute Necrotizing - surgery
Postoperative Complications - epidemiology
Reoperation
Retrospective Studies
Therapeutic Irrigation
Treatment Outcome
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Summary:Background and Aim:  Surgery for pancreatic necrosis complicating acute severe pancreatitis carries a high risk of morbidity and mortality. We evaluated the efficacy of necrosectomy and closed lesser sac lavage as a method of management of pancreatic necrosis. Methods:  Fifty‐eight patients with pancreatic necrosis who underwent pancreatic necrosectomy consecutively in a tertiary care referral center were retrospectively analyzed. The technique of necrosectomy and postoperative lavage is described in detail. Details regarding the patient profile, disease severity, surgical details, postoperative morbidity, repeat interventions and the mortality are presented. Results:  Of the 58 patients, irrigation was able to be started in 48. Lavage was able to be continued until disease resolution or death in all but 10 patients. Post‐operative locoregional complications were residual abscesses in 10, bleeding in eight, enteric fistulae in 12 and pancreatic fistulae in nine. Six patients needed postoperative percutaneous procedures, while 16 patients needed repeat surgery. Seventeen patients died (29%), all of whom had multiple organ failure involving more than two organs, while 11 developed sepsis. Conclusion:  Pancreatic necrosectomy and postoperative closed lesser sac lavage is an effective method of managing these patients, with acceptable morbidity, re‐operation rates and mortality.
ISSN:0815-9319
1440-1746
DOI:10.1111/j.1440-1746.2004.03434.x