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Surgery For Necrotizing Pancreatitis After Intensive Care

Patients with sterile necrosis should undergo surgery when there is no clinical improvement within four weeks of intensive care treatment.

This finding was one of the main conclusions of a study of 306 patients with acute pancreatitis.

Necrotizing pancreatitis was found in 121 of the patients. Infected necrosis was verified in 41 patients at a mean of 26 days. Four percent of patients with sterile necrosis and 95% of patients with infected necrosis underwent surgery. The initial surgery was successful in 83% of patients. Relaparotomy had to be performed in 17% of patients (seven patients). Pancreatic abscesses were found in seven patients and were drained interventionally in four.

The researchers, led by Werner Hartwig of the Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld, Heidelberg, Germany, reported, "The overall mortality of the patients with necrotizing pancreatitis was 9.9%. The mortality of patients with sterile and infected necrosis was 2.5% and 24%, respectively."

The investigators observed that because of improved intensive care treatment that included prophylactic antibiotics, surgical intervention is now not usually indicated in the early course of severe acute pancreatitis. However, surgery is clearly indicated in patients with proven infected necrosis. In most patients, a single intervention is enough. They said, "Reinterventions are rare and even in patients with abscess formation are not needed, because these can easily be drained interventionally."
Journal of Hepato-Biliary-Pancreatic Surgery 2002;9(4):429-435. "Surgical management of severe pancreatitis including sterile necrosis"

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