A retroperitoneal approach for infected pancreatic necrosis

Background. Acute pancreatitis remains associated with a high rate of complication and death. The surgery strategy for proven or suspected infected necrosis is controversial. Methods. The present study reviews the medical records of 9,421 patients admitted with the diagnosis of acute pancreatitis from 2002 to 2009. Results. The medical records of 9,421 admitted patients diagnosed with acute pancreatitis were reviewed. Among the patients, 412 received necrosectomy. Of the 412 that were identified, 108 patients underwent retroperitoneal necrosectomy, whereas the remaining 304 patients received open necrosectomy. The mortality rates were 20.4% (62/304) and 8.3% (9/108), respectively (p = 0.004). The rates of complications in the retroperitoneal group were lower than that in the open group (p < 0.05). The mean lengths of hospital stay and ICU stay after surgery were longer in the open group than those in the retroperitoneal group (48 vs. 30 days; 6 vs. 2 days, p < 0.05). Furthermore, the postoperational days in the hospital and surgical time were also significantly different (30 vs. 12 days; 167 vs. 93 min, p < 0.05). Conclusions. A retroperitoneal pancreatic necrosectomy approach reduced the rate of complications and death among patients with infected necrosis, compared with open necrosectomy.