[The indications for celiostomy in acute necrotizing pancreatitis]

The aim of this study was to analyze the indication and results of open pancreatic drainage by celiostomy in severe necrotizing pancreatitis (SNP). 44 patients with SNP were treated surgically by open lesser-omental sac drainage (celiostomy) in the last nine years (1989-1997). They were classified into three groups according to date (timing) of celiostomy: a group of 23 patients with early celiostomy (in the first week after the onset of pancreatitis); second group of 11 patients with celiostomy in the second and third week after SNP; the third group of 10 patients with late celiostomy (4-12 weeks after pancreatitis). Drainage procedure consisted in marsupialization of lesser omental sac by suturing open gastrocolic ligament to anterior peritoneum, with drains inserted via celiostomy. The indications of celiostomy in the first group were: diagnostic laparotomy for unknown acute abdomen (18 patients), severe acute cholecystitis (1 patient), common bile duct stones (2 patients), persistent MOSF (1 patient). The necrosectomy was technically possible only in eight patients (34.7%) at date of laparotomy. Postoperative infection of necrosis occurred in seven patients (30.4%) and nine patients died postoperatively (39.1%) because of aggravated MOSF. In the second group, celiostomy was carried out for extensive sterile (2 patients) or infected necrosis (9 patients). Good results were obtained in 9 patients and two patients with infected necrosis died postoperatively. In the third group late celiostomy was performed for treatment of the pancreatic abscess, with good results in all patients (0% mortality). In conclusion, celiostomy is drainage procedure of choice for patients with extensive infected pancreatic necrosis or pancreatic abscesses and stable biologic condition. It facilitates intermittent debridements of residual necrosis and purulent foci, without relaparotomies. Early celiostomy is not recommended as it is proved ineffective (nondemarcated necrosis) and may cause aggravation of SNP or exogenous infections of necrosis.