Infected pancreatic necrosis--an evaluation of the timing and technique of necrosectomy in a Southeast Asian population
Annals of the Academy of Medicine, Singapore
; : 523-530, 2006.
Article
in En
| WPRIM
| ID: wpr-275313
Responsible library:
WPRO
ABSTRACT
<p><b>INTRODUCTION</b>Acute pancreatitis appears to be less prevalent in multi-ethnic Southeast Asia, where the aetiology also appears to be influenced by ethnicity. As with acute pancreatitis elsewhere, however, pancreatic necrosis is a cause of significant mortality and the aim of this study was to review our institutional experience with pancreatic necrosectomy.</p><p><b>MATERIALS AND METHODS</b>The records of all patients who underwent pancreatic necrosectomy from January 2000 to December 2004 were analysed. Indications for surgery were the presence of infected necrosis, unresolving sepsis attributable to ongoing pancreatitis or the presence of gas in the pancreatic bed on imaging. Surgical debridement was achieved by debridement with closure over drains or by debridement with open packing.</p><p><b>RESULTS</b>The cohort comprised 14 of 373 patients admitted for acute pancreatitis (3.8%), with an overall mortality rate of 29%. All patients had infected necrosis with positive bacteriological cultures. Eight patients (57%) underwent debridement with closure over drains and 6 patients (43%) underwent debridement with open packing. All mortalities occurred in patients who underwent open packing, who were also associated with a higher mean Acute Physiology and Chronic Health Evaluation (APACHE) II score. The mortality rate in patients who underwent debridement less than 4 weeks after admission was 33% (2 of 6), compared with 25% (2 of 8) in patients who underwent debridement after 4 weeks. There were no mortalities in patients operated on after 6 weeks.</p><p><b>CONCLUSION</b>Surgical debridement with closure of drains and a policy of performing delayed necrosectomy are viable in our population.</p>
Full text:
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Index:
WPRIM
Main subject:
Pancreatectomy
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Asia, Southeastern
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General Surgery
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Time Factors
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Tomography, X-Ray Computed
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Drainage
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Epidemiology
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Cohort Studies
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Mortality
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APACHE
Type of study:
Diagnostic_studies
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Etiology_studies
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Incidence_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limits:
Adult
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Aged
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Female
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Humans
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Male
Country/Region as subject:
Asia
Language:
En
Journal:
Annals of the Academy of Medicine, Singapore
Year:
2006
Type:
Article