Author/Editor		Nespoli, Angelo; Nespoli, Luca
Title		The surgical treatment of infected pancreatic necrosis
Type		članek
Source		In: Pleskovič A, editor. Zbornik simpozija Kirurgija trebušne slinavke; 2002; Ljubljana. Ljubljana: Kirurška klinika, Klinični oddelek za abdominalno kirurgijo,
Publication year		2002
Volume		str. 52-61
Language		eng
Abstract		Objective: a retrospective multicenter study was carried out in a group of patients with documented infected pancreatic necrosis in order to evaluate differences in terms of mortality between patients submitted to continuous postoperative lavage or to the "so called" open treatment. Design: case series. Patients: 72 patients with infected pancreatic necrosis were evaluated. The Ranson index was determined at 48 hours after the admission and the APACHE II Score was calculated at the time of the first surgical procedure. After surgical necrosectomy 36 pts. were submitted in ICU, to open packing treatment while 36 pts., after the insertion of two or more large drainages, were submitted to continuous postoperative lavage. Results: we observed the same mortality rate (30,5%) in the two groups but Ranson indexes and APACHE II Scores were higher in the open treatment group than the one of continuous lavage. After APACHE II Score stratification the mortality rate was significantly lower in the open packing group in patients with APACHE II Score greater than 15. Conclusion: open treatment improves survival in patients with an APACHE II Score higher than 15. At a lower Score, between 10 to 15, the two kinds of treatment are equivalent to maintain a very low mortality rate; at a lower Score than 10 the open treatment may be considered too much invasive.
Descriptors		PANCREATITIS, ACUTE NECROTIZING INFECTION POSTOPERATIVE COMPLICATIONS TOMOGRAPHY, X-RAY COMPUTED APACHE