[Primary open therapy of acute necrotizing pancreatitis by the "open abdomen"]

There is no agreement about a conservative surgical strategy in the therapy of acute necrotizing pancreatitis yet. This report describes our experience with "open packing" laparostomy. This procedure is only performed when renal and pulmonary insufficiency is proceeding, despite optimal conservative treatment. Since 1986 15 patients were treated in this manner. Three compartments are established: an upper compartment (stomach, liver, spleen--covered by the omentum majus, which is dissected from the colon transversum); a lower compartment (small bowel--covered by the left colon) and the mid compartment that permanently opens the bursa omentalis and the left retrocolic space. Initially a careful necrosectomy is performed, followed by a tamponade. At the intensive care unit changing of the tamponade and lavage of the bursa omentalis was done every day. So far two patients have died pursuing this therapeutic regimen.