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Fascial closure in the management of infected pancreatic necrosis
T A Broughan1, R E Hermann, I J Hardesty
1Cleveland clinic Foundation, Ohio.
Abstract:
Reports have focused on the perceived benefit of a new method of managing pancreatic necrosis and sepsis: leaving the abdomen packed open after debridement, the "marsupialization" technique. We have continued to treat infected pancreatic necrosis with aggressive pancreatic debridement and drainage, closure of the abdomen, and prompt reoperation as often as necessary if further sepsis is identified. We report 52 consecutive patients with infected pancreatic necrosis operated upon between July, 1972 and March, 1990. Postoperative organ failure and APACHE II scoring correlated with survival. Patients with APACHE II scores less than 15 had an operative mortality rate of 4 per cent, whereas patients with scores greater than 15 had a 44 per cent mortality rate. We recognize that no two retrospective series are truly comparable, but in comparison to published reports on the open technique, fascial closure after pancreatic debridement appeared to produce fewer wound complications (only one dehiscence and one incisional hernia) and fewer trips to the operating room.
Insights
This study compared surgical approaches for infected pancreatic necrosis. Fascial closure after debridement resulted in fewer complications and reoperations compared to open packing techniques.
Area of Science:
- Surgery
- Gastroenterology
- Critical Care Medicine
Background:
- Infected pancreatic necrosis is a severe condition often managed with surgical debridement.
- The "marsupialization" technique, involving open abdominal packing, has been reported as a beneficial approach.
- An alternative involves abdominal closure and reoperation as needed.
Purpose of the Study:
- To compare the outcomes of fascial closure versus open packing for infected pancreatic necrosis.
- To evaluate the impact of the APACHE II score on survival in these patients.
Main Methods:
- Retrospective analysis of 52 consecutive patients with infected pancreatic necrosis treated between 1972 and 1990.
- Surgical management involved aggressive debridement, drainage, and either abdominal closure or open packing.
- Correlation of postoperative organ failure and APACHE II scores with patient survival.
Main Results:
- Patients with APACHE II scores < 15 had a 4% operative mortality rate.
- Patients with APACHE II scores > 15 had a 44% operative mortality rate.
- Fascial closure was associated with fewer wound complications (dehiscence, hernia) and fewer operating room returns compared to open techniques.
Conclusions:
- Aggressive debridement and drainage with abdominal closure, followed by prompt reoperation if necessary, is a viable management strategy for infected pancreatic necrosis.
- APACHE II scoring is a significant predictor of survival in patients with infected pancreatic necrosis.
- Fascial closure may offer advantages over open packing in reducing wound complications and the need for further surgical intervention.