Background: Infected pancreatic necrosis (IPN) is one of the most severe complications of
acute pancreatitis (AP). Sequential surgical debridement represents one of the most effective
treatments in terms of morbidity and mortality. The aim of this paper is to describe the quality
of life and long-term results (e.g., nutritional, muscular, and pancreatic function) of patients
treated by sequential necrosectomy at the Department of Surgery of the University of
Insubria (Varese, Italy).
Methods: Data were collected on patients undergoing sequential surgical debridement as
treatment for IPN. The severity of AP was evaluated using the Ranson criteria, the Acute Physiology
and Chronic Health Evaluation (APACHE II) Score, and the Sepsis Score, as well as
the extent of necrosis. The surgical approach was through a midline or subcostal laparotomy,
followed by exploration of the peritoneal cavity, wide debridement, and peritoneal lavage.
The abdomen was either left open or closed partially with a surgical zipper, with multiple
re-laparotomies scheduled until debridement of necrotic tissue was complete. The long-term
evaluation focused on late morbidity, performance status, and abdominal wall function.
Results: In the majority of patients (68%), mixed flora were isolated. Pseudomonas aeruginosa
was the microorganism identified most commonly (59%), often associated with Candida albicans
or C. glabrata. The mean total hospital stay was 71 ± 38 days (range 13–146 days), of which 24 ±
19 days (range 0–66 days) were in the intensive care unit. Eight patients died, the deaths being
caused by multiple organ dysfunction syndrome in seven patients and hemorrhage from the
splenic artery in one. Normal exocrine and endocrine pancreatic function was observed in 28 patients
(88%). At discharge, four patients had steatorrhea, which was temporary. Eight patients
(23%) developed pancreatic pseudocysts, and in six, cystogastostomy was performed. Most patients
(29/32, 91%) developed a post-operative hernia, but only five required surgical repair. All
patients had a Short Form (SF)-36 score >60%, and 20 of the 32 patients (68%) had scores >70–80%
(good quality of life). The worst scores were related to alcoholic pancreatitis.
Conclusions: The degree of pancreatic failure (exocrine and endocrine function) is not related
to the amount of pancreatic necrosis. Even with a need for repeated laparotomy and
multiple surgical procedures, the abdominal wall capacity as well as long-term quality of life
remain excellent.
