[Open necrosectomies after severe acute pancreatitis : is there still a place for it in 2024 ?]

Abstract

Introduction: the indication for pancreatic necrosectomy arises in a context of seriousness. Several factors can influence postoperative outcomes. Our objective is to identify the clinical and paraclinical factors which would influence the occurrence of complications after pancreatic necrosectomy.

Patients and methods: it is a retrospective study of the postoperative outcomes of patients treated by pancreatic necrosectomy from January 1th, 2019 to December 31th, 2023.

Results: fifty-nine cases were selected with sex ratio = 1.03 and mean age = 45 years [range 28;79]. The morbidity rate was 61 % (n = 36). The most frequent complication was postoperative hemorrhagic shock (n = 14) followed by septic shock (n = 12). Malnutrition, hyperleukocytosis, fasting > 5 days, bleeding > 500 ml, extensive necrosis (30 % - 50 %), a long stay in intensive care (> 5 days) were related to serious complications (p < 0.001). Antibiotic therapy, and the number of drains was not associated to the occurrence of severe morbidity.

Conclusion: both the severity of the disease and the patient's condition were related to the prognosis. The right timing for surgery is recommended to avoid serious complications.