Acute necrotizing pancreatitis: intra-abdominal vacuum sealing after necrosectomy.

摘要

BACKGROUND: Cases of acute pancreatitis with infected pancreatic necrosis warrant consideration of surgical interventions designed to achieve the goal of pancreatic debridement and drainage. Notable experience with the use of vacuum assisted closure for abdominal wall defects was an assumption for its peripancreatic application after debridement in septic patients with infected pancreatic necrosis confirmed by radiological evidence of gas or results of fine needle aspiration. The goal of this study was to evaluate our own experience with this new therapeutic technique. METHODS: This study is a multi-center retrospective analysis and comparison of 2 groups of patients with severe sepsis and a proven pancreatic source of infection. Group A consisted of 67 patients, 42 men and 25 women with ages ranging from 19-90 years (mean 48.0), who were treated surgically between 2002 and 2006 using a combination of laparostomy, multiple irrigations and abdominal drainage. Group B consisted of 39 patients, 28 men and11 women aged from 18-87 years (mean 51.8), who were treated between 2002 and 2006 using the former techniques with the addition of an intra-abdominal vacuum assisted negative pressure therapy system. RESULTS: The number of repeat laparotomies with debridement of the open abdominal wound in general anesthesia in group A ranged from 5-18 over 10-33 days (median 21) of surgical treatment period. The number of repeat laparotomies in group B decreased to 3-9 and the surgical treatment period decreased to 9-29 days (median 16). Seventeen patients (25.4%) in group A died because of severe sepsis and multiple organ failure, compared to 7 patients (17.9%) in group B. CONCLUSION: Authors confirmed significant reduction of morbidity and mortality with the use of the intra-abdominal vacuum assisted system in the treatment of localized pancreatic source of sepsis.