Septic pancreas necrosis: is it an absolute or a relative indication for surgery?

Aims: In the last years the absolute indication for surgery in septic necrosis became to be questionable. It is not well defined when operate if the infection of the necrosis is certified. Authors analyse the treatment and results of 137 patients with severe acute pancreatitis and try to find the answer for this questions.

Patients and methods: The authors used nasojejunal feeding, Imipenem-Cilastatin antibiotics, percutaneous peripancreatic drainage if needed and postponed operation in the 137 patients (93 male, 44 female, mean ages of 45.6 years) classified as severe acute pancreatitis by Atlanta classification. Surgery was indicated if the necrosis was infected and/or the percutaneous drainage was ineffective. The 35% of the cases (47 patients) had infected necrosis.

Results: Of the 47 patients 10 (21.3%) recovered after percutaneous drainage and conservative therapy without surgery. 33 (70.2%) underwent operation. In other 4 (8.5%) patients the interventional drainage was ineffective and later operation. Became inevitable the mortality rate of the 137 patients was 14.6%.

Conclusion: On the basis of the results authors suggest that infected necrosis is not an urgent, absolute indication for surgery. The 21.3% of the patients with septic necrosis recovered without surgery. If the percutaneous drainage and conservative therapy is ineffective operation is needed.