Open pancreatic necrosectomy morbility and mortality

Abstract

Background and aim: Open pancreatic necrosectomy is a surgical procedure used in infected acute necrotizing pancreatitis with a mortality that varies between studies from 6% to 80% and a morbidity that exceeds 50% of the cases. In Costa Rica there are no studies related to this surgery so a retrospective, observational and control study was done with the objective of knowing the surgical results in our center and comparing it with the world statistics and to identify patterns that modify mortality.

Methods: Observational, descriptive and retrospective case-control study. All patients undergoing open pancreatic necrosectomy at the ""Dr. R. A. Calderón Guardia"" from January 1, 2006 to June 0, 2014 were reviewed. All patients who died after a pancreatic necrosectomy for necrotizing pancreatitis were defined as cases, and as a controls, all patients who survived after diagnosis and surgery. Results: In the period 2006 to 2014 in our tertiary center Hospital Calderón Guardia 28 cases were obtained, with the following results: average age of 47.7 years, 17 men and 11 women, severe acute pancreatitis was found in 89.3% of cases with cholelithiasis and alcohol ingestion as the main causes. Surgical indications were pancreatic and/or peripancreatic infected collection and pancreatic necrosis, surgical time average of 17.3 days, midline approach with necrosectomy and packing, plus open abdomen mostly used. On average, 6.3 surgeries per patient were made, with mean days in ICU and hospital stay of 26.6 and 47.5 days each. Most frequent pancreatic complications were pancreatic fistula in 53.6% of cases, postoperative abscesses in 53.6%, and mortality of 35.7%. Regarding mortality it was found that intestinal perforation was a risk factor for death and pancreatic fistula a protective factor. Conclusion: at the study hospital open pancreatic necrosectomy is a high morbidity and mortality procedure.