Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique
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 patie...
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Published in | The American journal of surgery Vol. 175; no. 2; pp. 91 - 98 |
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Main Authors | , , , , , , |
Format | Journal Article |
Language | English |
Published |
New York, NY
Elsevier Inc
01.02.1998
Elsevier Elsevier Limited |
Subjects | |
Online Access | Get full text |
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Summary: | 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. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0002-9610 1879-1883 |
DOI: | 10.1016/S0002-9610(97)00277-8 |