[Open treatment in acute severe pancreatitis]

Area of Science:

• Surgery
• Intensive Care Medicine
• Gastroenterology

Background:

• Infected pancreatic necrosis (IPN) with multiple organ failure (MOF) has a high mortality rate.
• Predictive scores like Ranson and APACHE II, along with Balthazar CT classification, indicate severe disease.
• Previous treatments have shown limited success in improving outcomes for IPN and MOF.

Purpose of the Study:

• To describe the technical procedures for open packing used in managing IPN with MOF.
• To report the outcomes of open packing in a cohort of critically ill patients.
• To evaluate the effectiveness of open packing in reducing mortality in severe IPN and MOF.

Main Methods:

• Open packing procedures were performed on thirteen patients with IPN and MOF.
• Patients were assessed using Ranson score, APACHE II, and Balthazar CT classification.
• Daily debridement and continuous lavage were employed during treatment.

Main Results:

• The study included thirteen patients with a mean Ranson score of 6, mean APACHE II score of 20, and mean of 4 failing organs.
• All patients had documented necrosis; six were Balthazar D and seven were Balthazar E.
• The observed mortality rate was 25%, significantly lower than the predicted 70-80% based on severity scores.

Conclusions:

• Open packing is a viable and effective treatment for infected pancreatic necrosis.
• This technique demonstrates significant success in reducing mortality, especially in cases complicated by multiple organ dysfunction.
• The observed outcomes suggest open packing should be considered a primary treatment modality for severe IPN and MOF.