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Early surgical intervention in severe acute pancreatitis: C entral A ustralian experience
Author(s) -
Jacob Abraham O.,
Stewart Penny,
Jacob Ollapallil
Publication year - 2016
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.12707
Subject(s) - medicine , acute pancreatitis , abdominal compartment syndrome , intensive care unit , intensive care , pancreatitis , mechanical ventilation , systemic inflammatory response syndrome , apache ii , organ dysfunction , disease , multiple organ dysfunction syndrome , intensive care medicine , sepsis , abdomen , surgery
Background Severe acute pancreatitis ( SAP ) is a disease associated with a high mortality and morbidity; however, many patients survive due to better understanding of the disease and multidisciplinary care. Those who do not respond to intensive care management with persistent multi‐organ dysfunction still have a high mortality. There is a role for early surgical intervention in two subsets of critically ill patients: the first, with acute compartment syndrome ( ACS ) of the abdomen with persisting organ dysfunction despite medical measures to control intra‐abdominal pressure; the second, being early infected pancreatic necrosis ( IPN ) with the presence of gas in the retroperitoneum. Methods The current analysis is an 8‐year (2005–2012) study. The data were collected prospectively by the S urgical D epartment in A lice S prings H ospital. Intensive care data were also sourced from ANZICS CORE ( A ustralia and N ew Z ealand I ntensive C are S ociety and C entre for O utcome and R esource E valuation) for ICU (intensive care unit) mortality comparison between ICUs of A ustralia and N ew Z ealand with A lice S prings. Results There were 1163 episodes of acute pancreatitis with an annual incidence of 275 per 100 000. Of importance, 114 patients had SAP of whom 42 developed pancreatic necrosis. Eleven patients required surgical intervention. Five patients had decompressive laparotomies for ACS and six patients had laparotomies for IPN . The mortality of patients with SAP was 0%. Conclusions The two subsets of patients with either ACS or early IPN require early surgical intervention either by decompressive laparotomy or open necrosectomy with laparostomy. The authors attribute improved survival in this cohort due to these interventions.