[Closed marsupialization and delayed marsupialization in the treatment of severe pancreatitis]

The timing for surgical intervention and the type of operation in the treatment of severe pancreatitis are still controversial. In this study, we used closed marsupialization in which early operation was preferable and after decompression of the pancreas and necrosectomy, both edges of the opened greater omentum were sutured respectively to the upper and lower peritoneal borders of the transverse abdominal incision, forming a marsupium separating the greater and lesser abdominal cavities from each other. The abdominal incision was then sutured to close the opening of the marsupium. Should clinical features or CT, BUS scan have indicated the existence of pancreatic abscess a week or longer after the exploration, stiches of the abdominal wall incision were removed. The marsupium was easily reentered and necrotic tissue removed. As the omentum edges were adhered to the abdominal wall incision separating the greater and lesser abdominal cavities, reoperation was safe. The incision was then kept open (delayed marsupialization). The theoretical basis of the operation and satisfactory clinical results are discussed.