Surgical results for severe acute pancreatitis--comparison of the different surgical procedures

We compared the outcome of surgery for the patients with severe acute pancreatitis using different surgical procedures to find risk factors for mortality.

Records of eighty six patients with severe acute pancreatitis who underwent different surgical procedures in the past five years were retrospectively reviewed.

The patients were found to have severe acute pancreatitis during operation. The morbidity and mortality of three different surgical procedures were compared. The risk factors related to the mortality were analyzed. Thirty one patients considered as group A received debridement and closed sump drainage. Forty patients considered as group B receiving necrosectomy with open packing of the peripancreatic space. The other 15 patients considered as group C received debridement and continuous lavage of the lesser sac. The patients in group A had highest mortality (48.4%) and those in group B had lowest (15%).

The significant risk factors of mortality included high Ranson's signs, peripancreatic necrosis, pancreaticogenic ascites and bacterial infection. The open packing or marsupialization of group B provided an easy way to perform repeated debridement after the first operation, resulting in the lower mortality for severe acute pancreatitis than other surgical procedures. The procedure with closed sump drainage resulted in higher incidence of postoperative bleeding and sepsis. The patients with higher Ranson's signs, peripancreatic necrosis, pancreatic ascites or positive bacterial infection should be treated more aggressively.