Open Pancreatic Necrosectomy Is Still Safe and Effective Treatment for Pancreatic Necrosis Managed by Step-Up Approach

Necrotizing pancreatitis is the most dreadful evolution of acute pancreatitis. Intervention is generally required for infected pancreatic necrosis. Traditionally, the most widely used approach has been open pancreatic necrosectomy (OPN), but it is burdened by high morbidity and mortality. Recently, there has been a paradigm shift in the management (step-up approach) evolving towards minimal invasive techniques depending upon availability of resources and expertise. However, OPN still remains the technique of choice in selected cases and in centers where multidisciplinary team is not available. The aim of the study was to analyze the treatment outcome of pancreatic necrosis by step-up approach and OPN. Retrospective analysis of all patients with pancreatic necrosis requiring intervention during 2015-2019 was done. Patient's demographics, etiology, CT severity scoring, organ failure, and operative complications were analyzed. A total of fifteen patients (out of 80 necrotizing pancreatitis) with suspected or proven infected walled-off necrosis were enrolled. Twelve (80%) were male with mean age of 43.2 years. The most common etiology was alcohol. The mean APACHE II and modified CTSI score was 10.6 and 8.5 respectively. Three (20%) patients had isolated, and eight (53.3%) had multiple organ failure. Two (13.3%) patients were exclusively managed with percutaneous catheter drainage. OPN was performed in the remaining thirteen (86.6%) patients. The overall morbidity and mortality was seen in 46.6% and 26.6% patients respectively. In resource-limited setting, OPN is still safe and a feasible option with acceptable morbidity and mortality.