Acute Necrotizing Pancreatitis: Surgical Management with Capillary Drainage, Long-Term Lavage, and Continuous Enteral Nutrition

  • P. Frileux
  • P. H. Cugnenc
  • E. Fontaine
  • J. Honiger
  • L. Hannoun
  • E. Levy
  • R. Parc
Conference paper


While the protocols for assessment of the severity of necrotizing pancreatitis have been dramatically improved over the past 10 years, allowing differentiation of severe cases from benign forms of the disease, management of the most severe cases remains disappointing and controversial. The conventional techniques of sump drainage, associated with either debridement or pancreatic resection, are followed by a high mortality and morbidity, mainly due to septic complications and to the persistent active process of necrosis [1–8]. Conservative management with peritoneal lavage, although encouraging in the treatment of alcoholic pancreatitis [9, 10], has not proven beneficial in the subsequent randomized trials [11, 12]. Newer techniques of surgical management have been therefore utilized. Marsupialization, open packing, and open abdomen management have been proposed with the aim of providing a better drainage [13–17]. These methods are associated with a high morbidity, yet they do not achieve a thorough evacuation of the necrotic debris and are impaired by late recurrent abscesses [15] and local hemorrhage [17]. More recently, debridement followed by closed long-term lavage has been proposed by Beger et al. [18] and Nicholson et al. [19] with encouraging results.


Acute Pancreatitis Pancreatic Resection Pancreatic Necrosis Peritoneal Lavage Necrotizing Pancreatitis 
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Copyright information

© Springer-Verlag Berlin Heidelberg 1991

Authors and Affiliations

  • P. Frileux
  • P. H. Cugnenc
  • E. Fontaine
  • J. Honiger
  • L. Hannoun
  • E. Levy
  • R. Parc

There are no affiliations available

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