Complementary retroperitoneal lavage

Surgery is required in acute necrotic pancreatitis when ominous signs appear after three days of intensive medical therapy. The surgical procedure is outlined and retroperitoneal lavage is proposed as a necessary complement. A protocol for this procedure is given. We believe that removal of necrotic tissue is not synonymous with partial pancreatectomy. Lavage completes what we consider "lesional pancreatic surgery" by diluting, buffering and washing out residual caustic tissues. The resulting fistula is directed and spontaneously dries up in most cases.