Role of total pancreatectomy in the treatment of necrotizing pancreatitis

• DOI: 10.1007/bf01658002
• Publication Date: 2005-05-08T08:44:10Z
• Authors: Jean ‐Henri Alexa...; M. T. Guerrieri
• Keywords: Necrosis; 03 medical and health sciences; Pancreatectomy; 0302 clinical medicine; Pancreatitis; Duodenum; Acute Disease; Stomach; Drainage; Humans; 3. Good health

AbstractThe place of pancreatic resection in the treatment of acute pancreatitis is still much debated. Because of the bad results after insufficient resection, such as recurrence of extensive pancreatitis and infection, we decided to perform gastroduodenopancreatectomy (GDP) if more than 75% of the gland was necrotic.We have performed 52 operations for acute necrotizing pancreatitis since 1972 in the Surgical Clinic of Broussais Hospital; of 20 GDP patients, 8 are still alive. All have easily controlled diabetes,S were able to resume work, and 3 retired. After study of the deaths of the other patients, we conclude that it is important to carry out operative excision early, resecting all areas of necrosis before the lesions become the focus of uncontrollable infection. Four categories of patients are described on the basis of creatinine level, blood culture, appearance of the pancreas, and spread of necrosis. According to the gravity of the lesions treated with this method (necrosis of more than 75% of the pancreas), the death rate is usually 90% or higher. We believe that GDP offers the possibility of improvement.