Comparative Study of Conventional and Transgastric Necrosectomy for WideExtended Walled-of Pancreatic Necrosis

Purpose: Even though endoscopic necrosectomy for walled-off pancreatic necrosis is safe and effective, open surgery has an important role in cases with extended necrosis when the non-surgical approaches are not feasible. Authors compare their results of conventional and transgastric open necrosectomy. Methods: A total of 29 patients were treated with extended walled-off pancreatic necrosis. Conventional open necrosectomy with closed bursal lavage was performed in group A (18 patients) and transgastric necrosectomy was performed in group B (11 patients). There were no significant differences between the two groups related to sex, age, etiology of pancreatitis, size of WOPN and time elapsed from the onset of disease and surgery. Results: For all complications, the difference was significant between both groups (p=0.003). In group A, 13 reoperations were performed in 9 patients and none were required in group B. The difference between both groups was significant (p=0.01). The length of hospital stay was 23 ± 14.16 days in group A and 12 ± 2.2 days in group B. The difference was significant (p=0.001). The mortality in group A was higher than in group B (p=0.143), but it was not significant. The mean mortality rate was 13.8% in 29 patients. Conclusion: In patients with extended walled-off pancreatic necrosis, the open transgastric necrosectomy has better results than conventional necrosectomy.