Early and long term results of necrosectomy and planned re-exploration for infected pancreatic necrosis

Objective: To evaluate the early and long term results of necrosectomy, planned re-explorations and open drainage in patients with infected pancreatic necrosis.

Design: Retrospective and case control study.

Setting: University hospital, The Netherlands.

Subjects: 10 patients with documented infected pancreatic necrosis (Balthazar D and E) and 6 matched healthy volunteers who served as controls for assessment of pancreatic endocrine function.

Interventions: Planned re-explorations 24-hourly until necrosis was completely removed. At follow-up after 3 years intravenous glucose tolerance test in surviving patients and in healthy volunteers.

Main outcome measures: Mortality, intra-abdominal complications, long term pancreatic exocrine and endocrine function.

Results: Three patients died of multiple organ dysfunction. No patient developed a residual intra-abdominal abscess. Half of the patients developed complications including intra-abdominal haemorrhage, necrosis of the transverse colon and enterocutaneous fistula. One patient had steatorrhoea, another developed insulin dependent diabetes mellitus. Patients had impaired glucose tolerance but significantly (p <0.05) raised glucagon and insulin concentrations compared with matched healthy volunteers.

Conclusion: This treatment prevents residual intra-abdominal abscesses in patients with infected pancreatic necrosis but is associated with high morbidity. Surviving patients have impaired glucose tolerance, surprisingly accompanied by increased serum insulin and glucagon concentrations.