Is Early or Late Surgical Intervention More Beneficial in Acute Necrotizing Pancreatitis?

Abstract 

Objective

Infective necrotizing pancreatitis is widely accepted as a surgical disease, but the appropriate timing of surgical intervention is controversial. Some authors prefer early surgery, while most consensus and guidelines agree that late surgery has more benefit. We reviewed our institutional experience in the surgical management of necrotizing pancreatitis, focusing on the results of early and late surgical intervention.

Materials and Methods

Data for patients with necrotizing pancreatitis who underwent surgical intervention between July 1996 and June 2004 were analyzed. According to the timing of surgical intervention, they were subdivided into the early group (≤ 14 days after disease onset, 7 patients) and late group (> 14 days after disease onset, 11 patients).

Results

Patients in the early surgery group had more operations (mean, 3.86 vs. 1.36; p = 0.0342) and a higher mortality rate (42.8% vs. 0%; p = 0.043) compared to the late surgery group.

Conclusion

Our experience was that late surgery for necrotizing pancreatitis can lead to a lower mortality rate and is more beneficial to patients, which is in agreement with most consensus and guidelines.

Keywords:  Acute necrotizing pancreatitis , Debridement , Morbidity , Mortality , Necrosectomy

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