BACKGROUND: To evaluate the results of surgical treatment of acute necrotizing pancreatitis, as well as its necrotizing alcoholic form. METHODS: Patients were analyzed according to a prospective protocol. Surgery was performed on 68 patients due to necrotizing acute pancreatitis and acutized chronic pancreatitis from years 1982 to 2000. Patients were grouped into three categories: 1) Biliary acute pancreatitis; 2) Acute pancreatitis of unknown etiology; 3) Necrotizing alcoholic pancreatitis. RESULTS: Patients had the following clinical indications for laparotomy: 1) Uncertain diagnosis (32.3%); 2) Infected necrosis (60.3%); 3) Necrosectomy (7.4%). The surgical findings were: Infected necrosis (70.6%); biliary complicatios (20.6%) and large necrosis 1(7.4%). Global hospital mortality was 38.2%. Individual categories showed a mortality of 33.3% (biliary acute pancreatitis), 45.0% (undetermined acute pancreatitis) and 37.0% (necrotizing alcoholic pancreatitis). Reoperations were indicated once or more times in 25 patients, and among these, the mortality was 40%. Abscesses were the main cause of death (52.0%), and all the other complications that resulted in death invariably evolved to infection. CONCLUSIONS: The indications of early surgical treatment for gallbladder stones, as well as when the diagnosis is not clear, should be reduced to very specific circumstances. Reoperations are common in these patients and infection was the main immediate cause of death.
Pancreatitis; acute necrotizing; Surgery; Outcome assessment
