Per-Ola Park, Associate Professor, Frida Svensson, MD, Josefine Pettersson, MD, Maria Bergstrom, MD, PhD. Department of Surgery, South Alvsborgs Hospital
Introduction: Severe pancreatitis with necrosis has traditionally been treated with laparotomy and surgical necrosectomy, often resulting in high morbidity and mortality. During recent years, standard of care has shifted towards minimal invasive interventions seemingly decreasing morbidity and mortality. Simultaneously intensive care has evolved and contributes to better treatment results.
Methods: Retrospective study of case files comparing two time periods; 2000-2005 (previous group) with 2010-2015 (recent group) in a single centre. Severe pancreatitis was defined as organ failure for >48 hours. Patients with verified pancreatitis and > 48 hours in the ICU were included. Patient age, total hospital stay, ICU stay, surgical or minimal invasive interventions and mortality were recorded. All interventions related to the same episode of pancreatitis were included. Minimal invasive interventions include transgastric and percutaneous drainages.
Results: A total of 66 patients were identified, 38 in the previous group and 28 in the recent group. There were no differences in age (median 58,5(16-82)), time in ICU (median 5(2-67)) or total hospital stay (median 22(2-224)) between the groups.
During 2000-2005 5/38 patients had an acute open necrosectomy and 2 patients had an acute laparotomy due to colonic perforation/colonic obstruction. 3/38 received a percutaneous drainage. Two patients were operated with cyst marsupialization and necrosectomy at a later stage. In the recent group no open necrosectomies were performed but 3/28 patients had a laparotomy due to colonic perforation. 11/28 had a minimal invasive drainage; 5 transgastric, 3 percutaneous and 3 combined.
There was a significant difference in mortality between the two time-periods, 10/38 patients died during 2000-2005 and 1/28 died during 2010-2015 (p=0,01). Those who died were significantly older (69 years (51-79)) than the survivors (69 y (51-79)) (p=0,01). Five of the patients who died in the previous group died without any intervention. 4/5 of those who had an acute open necrosectomy died. Surgical necrosectomy correlated significantly with mortality (p=0,002). The only patient who died in the recent group died without any intervention. None of the 11 patients receiving minimal invasive drainage in this group died.
Conclusion: Mortality due to severe necrotising pancreatitis has decreased significantly with the introduction of minimal invasive techniques for drainage of pancreatic necrosis and abscesses. The simultaneous improvements in intensive care regimes may also contribute to better survival for these patients.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88044
Program Number: P723
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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