Brief Article
Copyright ©2011 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 21, 2011; 17(3): 366-371
Published online Jan 21, 2011. doi: 10.3748/wjg.v17.i3.366
Analysis of the delayed approach to the management of infected pancreatic necrosis
Nilesh Doctor, Sujith Philip, Vidhyachandra Gandhi, Maharra Hussain, Savio G Barreto
Nilesh Doctor, Sujith Philip, Vidhyachandra Gandhi, Department of Gastrointestinal Surgery, Jaslok Hospital and Research Center, Mumbai, 400026, India
Maharra Hussain, Department of Surgery, Bhatia Hospital, Mumbai, 400026, India
Savio G Barreto, Department of General and Digestive Surgery, Flinders Medical Center, Adelaide, 5042, South Australia
Author contributions: Philip S and Gandhi V were involved in collecting and analyzing the data; Hussain M and Barreto SG were also involved in editing the manuscript; Doctor N designed and wrote the manuscript.
Correspondence to: Dr. Nilesh Doctor, Department of Gastrointestinal Surgery, Jaslok Hospital and Research Center, Mumbai, 400026, India. drnileshbela@gmail.com
Telephone: +91-22-23696031 Fax: +91-22-23801815
Received: July 20, 2010
Revised: September 2, 2010
Accepted: September 9, 2010
Published online: January 21, 2011
Abstract

AIM: To analyze outcomes of delayed single-stage necrosectomy after early conservative management of patients with infected pancreatic necrosis (IPN) associated with severe acute pancreatitis (SAP).

METHODS: Between January 1998 and December 2009, data from patients with SAP who developed IPN and were managed by pancreatic necrosectomy were analyzed.

RESULTS: Fifty-nine of 61 pancreatic necrosectomies were performed by open surgery and 2 laparoscopically. In 55 patients, single-stage necrosectomy could be performed (90.2%). Patients underwent surgery at a median of 29 d (range 13-46 d) after diagnosis of acute pancreatitis. Sepsis and multiple organ failure accounted for the 9.8% mortality rate. Pancreatic fistulae (50.8%) predominantly accounted for the morbidity. The median hospital stay was 23 d, and the median interval for return to regular activities was 110 d.

CONCLUSION: This series supports the concept of delayed single-stage open pancreatic necrosectomy for IPN. Advances in critical care, antibiotics and interventional radiology have played complementary role in improving the outcomes.

Keywords: Necrosectomy, Infected necrosis, Pancreas, Severe acute pancreatitis, Inflammation