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Resection of the pancreas for acute fulminant pancreatitis
Abstract:
The records of 30 consecutive patients treated by pancreatic resection for acute hemorrhagic or necrotizing pancreatitis from 1974 to 1978 were reviewed. Formal subtotal or near to total resection of the pancreas was undertaken whenever vigorous nonoperative therapeutic measures did not bring rapid improvement of the condition of the patient. The rationale was that removal of the diseased pancreatic tissue would prohibit the progress of inflammation and abolish the development of complications directly associated to the inflammatory process itself. There was no intraoperative mortality, but 11 patients died after the operation. Of the 19 survivors, eight had an uncomplicated postoperative course, whereas 11 patients recovered only after severe complications, usually requiring multiple reoperations. Among the most important complications were intra-abdominal sepsis, septicemia, upper gastrointestinal tract bleeding, respiratory insufficiency, renal insufficiency and perforations of the gastrointestinal tract. After a follow-up period of one to five years, five patients have remained completely free of symptoms. In 12 patients, diabetes has developed, and four patients had recurrent mild attacks of pancreatitis. All but two patients have resumed their previous work or other activities of living.
Insights
Pancreatic resection for severe pancreatitis showed high mortality and complication rates. While some patients recovered fully, many developed long-term issues like diabetes or recurrent pancreatitis.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Critical Care Medicine
Background:
- Acute pancreatitis is a severe inflammatory condition with significant morbidity and mortality.
- Surgical intervention, specifically pancreatic resection, has been explored for severe cases unresponsive to nonoperative management.
- The efficacy and outcomes of pancreatic resection for acute pancreatitis require careful evaluation.
Purpose of the Study:
- To review the outcomes of pancreatic resection in patients with severe acute pancreatitis.
- To assess the complications and long-term sequelae following pancreatic resection for pancreatitis.
- To evaluate the rationale and effectiveness of pancreatic resection in managing severe pancreatitis.
Main Methods:
- Retrospective review of 30 consecutive patients undergoing pancreatic resection for acute hemorrhagic or necrotizing pancreatitis between 1974 and 1978.
- Pancreatic resection was performed when nonoperative measures failed to rapidly improve patient condition.
- Data collected included intraoperative and postoperative outcomes, complications, and long-term follow-up.
Main Results:
- No intraoperative mortality was observed.
- Postoperative mortality was 36.7% (11 out of 30 patients).
- Among 19 survivors, 8 had uncomplicated courses, while 11 experienced severe complications requiring reoperations, including sepsis, bleeding, and organ insufficiency.
- Long-term follow-up (1-5 years) revealed 5 asymptomatic patients, 12 with new-onset diabetes, and 4 with recurrent pancreatitis.
Conclusions:
- Pancreatic resection for severe acute pancreatitis is associated with substantial postoperative mortality and severe complications.
- While some patients may resume normal activities, a significant proportion develop long-term sequelae such as diabetes and recurrent pancreatitis.
- The aggressive surgical approach warrants careful consideration due to its high-risk profile.