Complications of surgical treatment of necrotizing pancreatitis

Surgical treatment of NP in appropriately selected patients has led to significantly decreased mortality from this disease. However, short and long- term morbidity remains high. Recurrent intraabdominal abscesses have proved to be less common after planned, repeated necrosectomy, can usually be drained percutaneously, and do not lead to increased mortality. Pancreaticocutaneous and gastrointestinal fistulae are common, conservative management is usually successful, and their presence does not compromise the outcome. Postoperative hemorrhage is not uncommon and, although it can be treated successfully with emergent operation, hemorrhage is associated with higher eventual mortality, probably because of a more severe underlying NP. Pancreatic insufficiency, especially endocrine insufficiency, occurs often (more commonly in alcohol-related NP) and is proportional tO the degree of parenchymal necrosis. Recurrent pancreatitis, recurrent pain, end incisional hernias are not as common, but they can occasionally pose especially challenging problems. Finally, patients who recover from NP generally have good functional outcome without a permanent change in quality of life after the initial convalescence.