Planned reoperative necrosectomy/debridement for necrotizing acute pancreatitis with delayed primary closure

Management of the peripancreatic bed after necrosectomy for surgical complications of acute necrotizing pancreatitis remains controversial. Since 1985, we have adopted a technique of planned, reoperative necrosectomy/debridement with eventual primary wound closure over peripancreatic drains. Using this approach in 47 patients, we have experienced an operative mortality of 23% and a recurrent intra-abdominal abscess rate of 13%, all but one of which were treated by simple percutaneous drainage. In contrast, 18 patients were managed by a single operative necrosectomy with placement of peripancreatic drains; their operative mortality was 33%, and all 3 patients who developed intra-abdominal abscesses required reoperation. We believe that a planned reoperative necrosectomy with eventual primary abdominal closure maximizes the success of complete necrosectomy and minimizes the incidence of recurrent (or persistent) intra-abdominal sepsis.