TBA (16S140)

Selective Necrosectomy For infected Pancreatic Necrosis

Author(s)

Ola Ahmed, Claire Donohoe, Niall Hardy, Daragh Murphy, Gerry McEntee

Department(s)/Institutions

Department of Hepatobiliary and Pancreatic Surgery

Department of Radiology

Introduction

Until recently, a diagnosis of infected pancreatic necrosis (IPN) warranted necrosectomy, which was associated with high morbidity and mortality rates greater than 20%. Pre-operative percutaneous drainage using radiologically guided techniques delayed the need for necrosectomy and the associated mortality with IPN improved considerably with recognition of the importance of delaying or avoiding operative intervention until initial organ impairment had resolved

Aims/Background

In 2008 this institution changed its approach to the management of cases of IPN opting instead for percutaneous drainage with selective deferred necrosectomy rather than routine open necrosectomy in all patients. This paper seeks to examine the result of this change in practice.

Method

Data on consecutive patients over the age of 18 with pancreatitis were collated prospectively in an institutional database between the dates of January 2008 and December 2014. Patient stratification was performed using the Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) scoring systems.

Results

Infected pancreatic necrosis was confirmed in 38 patients. All 38 underwent percutaneous radiological drainage and selective necrosectomy was performed on 15 where the infected necrosis did not completely resolve. 23 patients did not require surgery and were managed with pancreatic drain insertion, optimal nutritional and critical care interventions. Median peak APACHE and SOFA scores were 10 (range 0- 18) and 3 (range 0-10) prior to radiological intervention. The median total hospital stay was 41.5 days (range 5 – 262 days). Overall mortality was 5% (n=2).

Conclusions

The change in practice from routine to selective necrosectomy facilitated a much faster discharge with both medical and personal benefits and resulted in fewer surgical complications. This study demonstrates that radiological guided drainage of infected pancreatic collections can, in most cases, prove curative and, if not, facilitate delayed surgical intervention with improved outcomes