Sequential treatment of infected pancreatic necrosis with zipper abdominal reexplorations, open abdomen and continuous lavage

L. Dominioni, A. Chiappa, V. Bianchi, R. Dionigi

Research output: Contribution to journalArticle

Abstract

INTRODUCTION Improved survival of patients with infected pancreatic necrosis (IPN) has been obtained using either open treatment or continuous lavage; the mortality rate, however, ranges between 20 and 70%. We report here the clinical outcome of 14 patients with IPN treated with the combination of open treatment and continuous lavage. MATERIALS AND METHODS Fourteen consecutive patients (10 males, four females; 54+10 years) with bacteriologically proven IPN were treated, by the same surgical team, sequentially as follows. (1) Abdominal re-explorations through a zipper for 7-10 days. (2) Open abdomen and debridment for the following 7-10 days. (3) Continuous lavage with drainages, until resolution of infection. (4) Wound closure. Initial severity of IPN was assessed by CT scan (infected necrosis <30% in 3 patients, 30-50% in 8 patients and > 50% in 3 patients), by sepsis score of Elebute-Stoner (16 + 5), and by Goris' score of MOF(5±1). RESULTS Patients underwent 9 + 4 abdominal re-explorations. Subsequent continuous lavage lasted 15-85 days; no patients required further re-explorations. Mortality was 3/14 patients (21%), due to MOF. The 11 survivors (79%) were discharged with closed abdominal wound, feeding orally, after 79 ±34 days, with no fistulae. CONCLUSION With combined sequential use of abdominal re-explorations, open drainage and continuous lavage, in a consecutive series of patients with very severe (as assessed by multiple scoring systems) IPN, we observed a mortality rate of 21% which ranks among the lowest reported for IPN of similar severity.

Original languageEnglish
Pages (from-to)288
Number of pages1
JournalJournal of the Royal College of Surgeons of Edinburgh
Volume41
Issue number4
Publication statusPublished - 1996

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Therapeutic Irrigation
Abdomen
Necrosis
Therapeutics
Mortality
Drainage
Wounds and Injuries
Fistula
Survivors
Sepsis
Survival
Infection

ASJC Scopus subject areas

  • Surgery

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Sequential treatment of infected pancreatic necrosis with zipper abdominal reexplorations, open abdomen and continuous lavage. / Dominioni, L.; Chiappa, A.; Bianchi, V.; Dionigi, R.

In: Journal of the Royal College of Surgeons of Edinburgh, Vol. 41, No. 4, 1996, p. 288.

Research output: Contribution to journalArticle

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abstract = "INTRODUCTION Improved survival of patients with infected pancreatic necrosis (IPN) has been obtained using either open treatment or continuous lavage; the mortality rate, however, ranges between 20 and 70{\%}. We report here the clinical outcome of 14 patients with IPN treated with the combination of open treatment and continuous lavage. MATERIALS AND METHODS Fourteen consecutive patients (10 males, four females; 54+10 years) with bacteriologically proven IPN were treated, by the same surgical team, sequentially as follows. (1) Abdominal re-explorations through a zipper for 7-10 days. (2) Open abdomen and debridment for the following 7-10 days. (3) Continuous lavage with drainages, until resolution of infection. (4) Wound closure. Initial severity of IPN was assessed by CT scan (infected necrosis <30{\%} in 3 patients, 30-50{\%} in 8 patients and > 50{\%} in 3 patients), by sepsis score of Elebute-Stoner (16 + 5), and by Goris' score of MOF(5±1). RESULTS Patients underwent 9 + 4 abdominal re-explorations. Subsequent continuous lavage lasted 15-85 days; no patients required further re-explorations. Mortality was 3/14 patients (21{\%}), due to MOF. The 11 survivors (79{\%}) were discharged with closed abdominal wound, feeding orally, after 79 ±34 days, with no fistulae. CONCLUSION With combined sequential use of abdominal re-explorations, open drainage and continuous lavage, in a consecutive series of patients with very severe (as assessed by multiple scoring systems) IPN, we observed a mortality rate of 21{\%} which ranks among the lowest reported for IPN of similar severity.",
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N2 - INTRODUCTION Improved survival of patients with infected pancreatic necrosis (IPN) has been obtained using either open treatment or continuous lavage; the mortality rate, however, ranges between 20 and 70%. We report here the clinical outcome of 14 patients with IPN treated with the combination of open treatment and continuous lavage. MATERIALS AND METHODS Fourteen consecutive patients (10 males, four females; 54+10 years) with bacteriologically proven IPN were treated, by the same surgical team, sequentially as follows. (1) Abdominal re-explorations through a zipper for 7-10 days. (2) Open abdomen and debridment for the following 7-10 days. (3) Continuous lavage with drainages, until resolution of infection. (4) Wound closure. Initial severity of IPN was assessed by CT scan (infected necrosis <30% in 3 patients, 30-50% in 8 patients and > 50% in 3 patients), by sepsis score of Elebute-Stoner (16 + 5), and by Goris' score of MOF(5±1). RESULTS Patients underwent 9 + 4 abdominal re-explorations. Subsequent continuous lavage lasted 15-85 days; no patients required further re-explorations. Mortality was 3/14 patients (21%), due to MOF. The 11 survivors (79%) were discharged with closed abdominal wound, feeding orally, after 79 ±34 days, with no fistulae. CONCLUSION With combined sequential use of abdominal re-explorations, open drainage and continuous lavage, in a consecutive series of patients with very severe (as assessed by multiple scoring systems) IPN, we observed a mortality rate of 21% which ranks among the lowest reported for IPN of similar severity.

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