Complications after pancreatic resection for acute necrotizing pancreatitis

The risks of pancreatic resection for acute necrotizing pancreatitis were evaluated in 37 patients, all with greater than or equal to 3 positive Ranson signs, most with extensive peripancreatic fat necrosis and almost half with extensive parenchymal necrosis. The mortality (43%), though comparable with most other reports, was higher than in the authors' earlier experience. The reason was not clear. Postoperative bleeding from the surgical field was the most common problem, being responsible for half of the deaths. Septicaemia due to abscess or fistulation occurred in eight patients and was fatal in five. Pulmonary and renal complications were common, but caused only three deaths. Time from onset of symptoms to operation did not influence complications or age-matched mortality. With increasing extent of resection, lung complications diminished, but not other complications or mortality. All patients older than 60 died. Resection thus should be avoided for the elderly, and its role in younger cases remains far from clear. The postoperative complications and insignificantly lower death rate than after other treatments have diminished the former enthusiasm for resection in acute necrotizing pancreatitis.