Controlled open lesser sac drainage for pancreatic abscess

Area of Science:

• Gastroenterology
• Surgical Oncology
• Critical Care Medicine

Background:

• Pancreatic abscesses are associated with high morbidity and mortality.
• Traditional closed drainage (CD) methods have limitations in managing severe cases.
• Controlled open lesser sac drainage (COLD) has been proposed as a potentially superior alternative.

Purpose of the Study:

• To compare the outcomes of COLD versus CD in patients with pancreatic abscess.
• To evaluate the effectiveness of COLD in patients with severe pancreatitis and systemic sepsis.

Main Methods:

• A retrospective study of 81 consecutive patients with surgically managed pancreatic abscesses between 1966 and 1985.
• Patients were divided into two groups: COLD (n=17) and CD (n=64).
• Comparison of demographic, clinical, and outcome data, including mortality rates and Ranson signs.

Main Results:

• Despite a higher proportion of patients with severe sepsis and increased risk of death (Ranson signs ≥3) in the COLD group, overall mortality was significantly lower (18% vs. 44%, p<0.05).
• In high-risk patients (Ranson signs ≥3), mortality was substantially reduced with COLD (18% vs. 70%, p<0.05).
• COLD involves debridement, open packing, suction drainage, and lavage.

Conclusions:

• Controlled open lesser sac drainage (COLD) is a more favorable treatment for pancreatic abscess, particularly in patients with severe pancreatitis and overt systemic sepsis.
• COLD demonstrates a significant reduction in mortality compared to closed drainage in high-risk surgical patients.
• This study suggests COLD may be the preferred surgical strategy for complex pancreatic abscesses.