[Parenchymal necrosis: infection and other indications for debridement and drainage]

In the present review we describe our experience with debridement in necrotizing pancreatitis, with particular emphasis on the indications for surgery and the outcome in patients with infected and sterile necrosis. Within 7 years 64 patients with necrotizing pancreatitis underwent surgery with a median preoperative APACHE II score of 9. The indications for surgery were either proven infection or persistence of symptoms. Thirty-six patients were found to have infected necrosis, while 28 patients had sterile necrosis. There was no significant difference between the two groups regarding pre- and postoperative parameters. The surgical technique involved a blunt necrosectomy followed by closed packing with Penrose drains. This technique produced the lowest reported mortality of 6.2% with a reoperation rate of only 17%, demonstrating that even with sterile necrosis surgical management can be carried out safely.