Transverse Laparotomy in the Treatment of Infected Pancreatic Necrosis
https://doi.org/10.16931/1995-5464.2016375-82
Abstract
Aim. To compare the outcomes after transverse and midline laparotomy for infected pancreatic necrosis and to evaluate
the safety and adequacy of drainage via transverse laparotomy.
Material and Methods. Surgical treatment of 47 cases of infected pancreatic necrosis was analyzed. We compared two groups: 13 patients underwent transverse laparotomy (group 1), 34 patients underwent midline laparotomy (group 2). In the first group anterior and posterior sheets of rectus sheath were stitched on both sides of the transverse incision. Omentobursostomy (OBS) was formed by stitching of gastrocolic ligament with sewn edges of the rectus sheath. Intraoperative blood loss, intensive care unit (ICU)/hospital stay, postoperative complication rate and mortality were
compared and analyzed.
Results. Necrosectomy was performed in all patients. In group 1 OBS was performed in 12 (92.3%) cases, in group 2 – in 22 (64.7%) cases. In 12 patients of group 2 OBS was not made. There was less intraoperative blood in group 1 compared with group 2 (178.0 ± 31.2 ml vs. 317.1 ± 38.7 ml )(p < 0.05). Purulent complications rate outside the surgical area was significantly less in group 1 (7.7% vs. 41.2%, p < 0.05). The incidence of pancreatic and biliary fistula were 7.7% (1 case) and 38.3% (13 cases) in both groups respectively (p < 0.05). ICU stay was 5.2 ± 1.6 days and 11.4 ± 1.8 days in groups 1 and group 2 respectively (p < 0.05). Postoperative mortality rate was 2 cases (15.4%) in group 1 and 12 cases
(35.2%) in group 2 (р > 0.05).
Conclusion. Necrosectomy through transverse laparotomy was accompanied by less intraoperative blood loss, fewer complications and provides adequate drainage that reduces ICU-stay.
About the Authors
V. M. Rusinov
Kirov State Medical Academy, Health Ministry of the Russian Federation
Russian Federation
Cand. of Med. Sci., Associate Professor of the Department of Hospital Surgery
Russian Federation
Cand. of Med. Sci., Associate Professor of the Department of Hospital Surgery
A. V. Patlasov
Kirov State Medical Academy, Health Ministry of the Russian Federation
Russian Federation
Russian Federation
Postgraduate Student of the Department of Hospital Surgery
V. A. Bakhtin
Kirov State Medical Academy, Health Ministry of the Russian Federation
Russian Federation
Doct. of Med. Sci., Professor, Head of the Department of Hospital Surgery
Russian Federation
Doct. of Med. Sci., Professor, Head of the Department of Hospital Surgery
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Review
For citations:
Rusinov V.M., Patlasov A.V., Bakhtin V.A. Transverse Laparotomy in the Treatment of Infected Pancreatic Necrosis. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2016;21(3):75-82. (In Russ.) https://doi.org/10.16931/1995-5464.2016375-82
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