Pancreatic Resection versus Peritoneal Lavation for Acute Fulminant Pancreatitis

Publisher Website
Google Scholar
Abstract
Patients (35) with acute fulminant (hemorrhagic) pancreatitis, verified at laparotomy, were allocated to either pancreatic resection (18 patients) or peritoneal lavation (17 patients) therapy gorups. Pancreatic resection was carried out by removing the distal pancreas well cephalad to the portal vein. For peritoneal lavation, 2 inlet silicone catheters were inserted at laparotomy around the pancreas and an outlet catheter was inserted in the lower abdomen and the peritoneal cavity was thereafter lavated (1000 ml/hr) with a standard peritoneal dialysis fluid for 7 to 12 days (or until death if met earlier). In other respects, the postoperative care was similar, including i.v. fluids with total parenteral nutrition until oral intake of food was resumed, prophylactic antibiotics (tobramycin and clindamycin) and stress ulcer prophylaxis (cimetidine and antacids). In the resection group, 4 of the 18 patients (22.2%) died, while in the lavation group 8 of the 17 patients (47.1%) died. The most common cause of death was septic complications with multiple organ failure, but 1 patient in each group died accidentally of airway complications. There was no difference in the incidence of septic complications (sepsis and/or intra-abdominal abscesses), but the incidence and severity of pulmonary and renal complications were greater in the lavation group. These complications accumulated to patients who ultimately died. The need for reoperation was greater in the lavation group (20 reoperations/10 patients vs. 12 reoperations/8 patients). The length of overall hospital stay was equal in the 2 groups. Six of the 14 survivors in the resection group developed diabetes, whereas none of the 9 survivors in the lavation group got this complication. Pancreatic resection evidently is superior to peritoneal lavation in the management of acute fulminant (hemorrhagic) pancreatitis, decreasing mortality and affording smoother postoperative course. These benefits are gained at the expense of higher incidence of postoperative diabetes.