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Reoperation for Severe Pancreatitis
A 10-Year Experience in a Tertiary Care Center
François Paye, MD;
Pascal Frileux, MD;
Paul Lehman, MD;
Jean-Marie Ollivier, MD;
Jean Christophe Vaillant, MD;
Rolland Parc, MD, FACS
Arch Surg. 1999;134:316-320.
Objectives To analyze the specific problems encountered in treating patients previously operated on for necrotizing pancreatitis and to determine the benefit of such a complex and demanding procedure.
Design and Setting Review of a case series in an academic tertiary care referral center.
Patients Forty-four consecutive patients referred and reoperated on in 10 years.
Interventions Reiterative laparotomy with complete debridment of all necrotic sites, followed by Mikulicz packing. Mikulicz packs were replaced by removable drains allowing both local prolonged lavage and open drainage of large solid necrotic debris. Enteral nutrition was performed through a feeding jejunostomy. Associated gastrointestinal tract lesions were simultaneously treated.
Main Outcome Measures Operative findings, bacteriological status of necrosis, in-hospital mortality, length of hospitalization, and surgical complications and their management.
Results Necrosis was infected in 36 (82%) of the 44 cases and associated gastrointestinal tract lesions were found in 20 (45%) of these patients. Mortality was 23%, and was significantly (P=.03) related to the preoperative clinical status. Surgical complications occurred in 31 (70%) of the 44 patients necessitating surgical treatment in 18 (41%) of these patients. Mean (± SD) stay in the intensive care unit was 66±8 days for survivors.
Conclusion This complex and demanding surgical procedure is worthwhile, yielding mortality rates comparable to those observed in de novo severe necrotizing pancreatitis.
From the Department of Digestive Surgery, Hôpital Saint-Antoine, University Pierre et Marie Curie, Paris, France.
RELATED ARTICLE
Invited Critique: Reoperation for Severe Pancreatitis
Edward L. Bradley III
Arch Surg. 1999;134(3):321.
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