Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique

Gregory G. Tsiotos, Enrique Luque-De León, Jon A. Söreide, Michael P. Bannon, Scott P. Zietlow, Yvonne Baerga-Varela, Michael G. Sarr

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Abstract

METHODS: From 1983 to 1995, 72 patients with necrotizing pancreatitis were treated with a general approach involving planned reoperative necrosectomies and interval abdominal wound closure using a zipper. RESULTS: Hospital mortality was 25%. Multiple organ failure without sepsis caused early mortality in 3 of 4 patients and sepsis caused late mortality in 11 of the remaining 14. The mean number of reoperative necrosectomies/debridements was 2 (0 to 7). Fistulae developed in 25 patients (35%); 64% were treated conservatively. Recurrent intraabdominal abscesses developed in 9 patients (13%) but were drained percutaneously in 5. Hemorrhage required intervention in 13 patients (18%). Prognostic factors included APACHE-II score on admission <13 (P = 0.005), absence of postoperative hemorrhage (P = 0.01), and peripancreatic tissue necrosis alone (P <0.05). CONCLUSIONS: The zipper approach effectively maximizes the necrosectomy and decreases the incidence of recurrent intraabdominal infection requiring reoperation. APACHE-II score ≤13, extensive parenchymal necrosis, and postoperative hemorrhage signify worse outcome.

Original languageEnglish (US)
Pages (from-to)91-98
Number of pages8
JournalAmerican Journal of Surgery
Volume175
Issue number2
DOIs
StatePublished - Feb 1998

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Pancreatitis
Postoperative Hemorrhage
APACHE
Sepsis
Abdominal Wound Closure Techniques
Necrosis
Intraabdominal Infections
Multiple Organ Failure
Mortality
Debridement
Hospital Mortality
Reoperation
Abscess
Fistula
Hemorrhage
Incidence

ASJC Scopus subject areas

  • Surgery

Cite this

Tsiotos, G. G., Luque-De León, E., Söreide, J. A., Bannon, M. P., Zietlow, S. P., Baerga-Varela, Y., & Sarr, M. G. (1998). Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique. American Journal of Surgery, 175(2), 91-98. https://doi.org/10.1016/S0002-9610(97)00277-8

Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique. / Tsiotos, Gregory G.; Luque-De León, Enrique; Söreide, Jon A.; Bannon, Michael P.; Zietlow, Scott P.; Baerga-Varela, Yvonne; Sarr, Michael G.

In: American Journal of Surgery, Vol. 175, No. 2, 02.1998, p. 91-98.

Research output: Contribution to journalArticle

Tsiotos, GG, Luque-De León, E, Söreide, JA, Bannon, MP, Zietlow, SP, Baerga-Varela, Y & Sarr, MG 1998, 'Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique', American Journal of Surgery, vol. 175, no. 2, pp. 91-98. https://doi.org/10.1016/S0002-9610(97)00277-8
Tsiotos GG, Luque-De León E, Söreide JA, Bannon MP, Zietlow SP, Baerga-Varela Y et al. Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique. American Journal of Surgery. 1998 Feb;175(2):91-98. https://doi.org/10.1016/S0002-9610(97)00277-8
Tsiotos, Gregory G. ; Luque-De León, Enrique ; Söreide, Jon A. ; Bannon, Michael P. ; Zietlow, Scott P. ; Baerga-Varela, Yvonne ; Sarr, Michael G. / Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique. In: American Journal of Surgery. 1998 ; Vol. 175, No. 2. pp. 91-98.
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