Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique

• Published in: The American journal of surgery Vol. 175; no. 2; pp. 91 - 98
• Main Authors: Tsiotos, Gregory G., León, Enrique Luque-de, Söreide, Jon A., Bannon, Michael P., Zietlow, Scott P., Baerga-Varela, Yvonne, Sarr, Michael G.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.1998; Elsevier; Elsevier Limited
• Subjects: Abscesses; Adult; Aged; Aged, 80 and over; APACHE; Biological and medical sciences; Debridement; Drainage - methods; Fasciotomy; Female; Fistulae; Hemorrhage; Humans; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Mortality; Necrosis; Pancreatitis; Pancreatitis, Acute Necrotizing - diagnostic imaging; Pancreatitis, Acute Necrotizing - surgery; Parenteral Nutrition, Total; Postoperative Complications; Prognosis; Prospective Studies; Recurrent infection; Reoperation; Sepsis; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tomography, X-Ray Computed; Wound healing; Human; Reoperation; Acute; Surgical drainage; Pancreatitis; Surgical closure; Necrosis; Treatment; Surgery; Debridment; Digestive diseases; Technique; Pancreatic disease
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(97)00277-8

From 1983 to 1995, 72 patients with necrotizing pancreatitis were treated with a general approach involving planned reoperative necrosectomies and interval abdominal wound closure using a zipper. Hospital mortality was 25%. Multiple organ failure without sepsis caused early mortality in 3 of 4 patients and sepsis caused late mortality in 11 of the remaining 14. The mean number of reoperative necrosectomies/debridements was 2 (0 to 7). Fistulae developed in 25 patients (35%); 64% were treated conservatively. Recurrent intraabdominal abscesses developed in 9 patients (13%) but were drained percutaneously in 5. Hemorrhage required intervention in 13 patients (18%). Prognostic factors included APACHE-II score on admission <13 ( P = 0.005), absence of postoperative hemorrhage ( P = 0.01), and peripancreatic tissue necrosis alone ( P <0.05). The zipper approach effectively maximizes the necrosectomy and decreases the incidence of recurrent intraabdominal infection requiring reoperation. APACHE-II score ≥13, extensive parenchymal necrosis, and postoperative hemorrhage signify worse outcome.