Open versus closed treatment of necrotizing pancreatitis

The records of 30 consecutive patients who underwent operative procedures for infected (25 patients) and sterile (5 patients) necrotizing pancreatitis were reviewed. 17 patients were managed by an open procedure and 13 patients by a closed procedure. Overall mortality was six patients (20%). All the mortalities were among the 25 infected patients and among the 16 patients managed open. Open management was associated with higher Apache II scores at admission (13.5 vs. 8.5) (p < .05). Nonsurvivors had a higher Ranson prognostic criteria score, first CT severity index, and Apache II score versus survivors (16.8 vs. 10) (p < .05). Open management was associated with more operations, more transfusions of blood, and longer length of intensive care unit and hospital stays. All mortalities were secondary to multiple organ failure. There were more local complications in the open group (fistulas and colon necrosis). At the initial operation, infected patients demonstrated predominantly emerging resistant flora. Open management is associated with a higher morbidity and mortality; however, due to the progressive nature of the pathology, repeated explorations are necessary in the more severely ill patients with necrotizing pancreatitis.