Drainage for Acute Necrotizing Pancreatitis

Abstract

Acute pancreatitis with pancreatic and peripancreatic necrosis involves a poor clinical course, although pathogenetic advances have improved prognosis. In sterile pancreatic necrosis, intensive nonoperative treatment including the administration of prophylactic antibiotics is essential. Patients with infected necrosis, however, require surgical intervention, which consists of necrosectomy and postoperative management entailing resection of remnant necrotic tissue and drainage. We discess the surgical management of infected pancreatic necrosis, including controversies regarding the surgical indication and timing and the choice of drainage, e.g., conventional drainage, open drainage, and closed lavage. No general consensus exists regarding surgical technique, largely because the distinction between infected necrosis and pancreatic abscess, the determination of severity, and the timing of surgery vary widely. Large prospective studies are thus required to determine optimal surgery for necrotizing pancreatitis.