Comparative assessment of different methods of surgical treatment of nonbiliary necrotizing pancreatitis

Abstract

Over the last decade, the issue of treatment of acute necrotizing pancreatitis has been requiring special attention because of the growth of this pathology worldwide and high mortality from it, especially with extended infected types of the disease. The aim of the research was to improve results of treatment of patients with nonbiliary necrotizing pancreatitis by optimizing of the surgical tactics, which depend on the extent of necrosis in the pancreas and peripancreatic fat. Materials and methods. The study analyzed results of treatment of 220 patients with acute nonbiliary necrotizing pancreatitis, who were hospitalized in the clinic from 2014 to 2016. The age of the patients ranged from 18 to 80 years, including patients under the age of 50, who accounted for 54 %. Comparison of qualitative features was carried out through analysis of conjugacy tables, using the χ² Pearson criterion (Pearson Chi-square). For four-field tables (for 1 degree of freedom), the Yates's correction was used. When comparing the groups, the level of statistical significance (P) was calculated. At P < 0.05, the differences were considered statistically significant. Results. The research argues that mortality depends not only on the extent of pancreatic necrosis, but also on the choice of method of surgical intervention. Use of puncture-draining operations under ultrasound control and lumbotomy made it possible to reduce postoperative mortality from lesser sac abscess from 6.5 % to 3.9 %, from retroperitoneal phlegmon – from 31.6 % to 15.8 %, and from their combination – from 60 % to 33.3 %. In cases of diffuse purulent peritonitis, mortality from laparostomy combined with the programmed sanitation of the abdominal cavity was 40 %; it included cases when carbapenem antibiotics (imipenem/cilastatin, and meropenem) were used in the complex treatment, accounting for 33.3 %, and cases of implementing laparostomy, sanitation, and drainage of the abdominal cavity, making 50 %. Conclusions. The more extensive use of puncture-draining operations under ultrasound control and lumbotomy, as well as laparostomy in combination with the programmed sanitation of the abdominal cavity, allowed to reduce mortality from 26.1 % to 12.1 %.

Keywords

• acute necrotizing pancreatitis
• necrosis
• surgical