ABSTRACT Aim: The goal of this study is to evaluate the open packing of the lesser sac (OPLS) in treatment of infected severe acute pancreatitis Methodology: The study was based on 98 cases in which this technique was applied during the period between 19942007, in two departments of surgery (Clinical Hospital CF 2 and Clinical Hospital ?Sf. Maria” Bucharest). The technique was applied based on the therapeutically protocol previously established beginning with 2000. The OPLS technique was analyzed relatively to: timing of surgery, the localization of the infected necrosis or abscesses, growing germs on the cultures, antibiotics received, executed primarily or at reintervention, the number of debridement, hospitalization, morbidity and mortality. The information was statistically processed using SPSS test version 17 for Windows. Results: The OPLS technique improved the control of the local sepsis, in the retrospective/prospective study in 83.7%. Mortality was 16.3% (16/98), with a global mortality of 26.3% (75/285) and a postoperative mortality of 29.5% (66/224). Conclusions: Considering the fact that the intensive care techniques are approximately the same in the last 15 years, we thought that this improvement in the survival rate may be due to the application of OPLS in cases with indication and optimal timing for surgery.
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nullD. Cochior, S. Constantinoiu, D. Peţa, M. Cochior, R. Bîrlă and L. Pripişi, "The Open Packing of the Lesser Sac Technique in Infected Severe Acute Pancreatitis," Surgical Science, Vol. 1 No. 1, 2010, pp. 7-14. doi: 10.4236/ss.2010.11002.
 M. W. Büchler, B. Gloor, C. A. Muller, H. Friess, C. A. Seiler and W. Uhl, “Acute Necrotizing Pancreatitis: Treatment Strategy According to the Status of Infection,” Annals of Surgery, Vol. 232, No. 5, 2000, pp. 619626.
J. A. Harris, R. P. Jury, J. Catto and J. L. Glover, “Closed Drainage Versus Open Packing of Infected Pancreatic Necrosis”, Annals of Surgery, Vol. 61, No. 7, 1995, pp. 612618.
M. Besselink, T. J. Verwer, E. Schoenmaeckers, E. Buskens, B. U. Ridwan, M. R. Visser, V. B. Nieuwenhuijs and H. G. Gooszen., “Timing of Surgical Intervention in Necrotizing Pancreatitis”, Archives of Surgery, Vol. 142, No. 12, 2007, pp. 11941201.
King NK, Siriwardena AK, “European Survey of Surgical Strategies for the Management of Severe Acute Pancreatitis,” The American Journal of Gastroenterology, Vol. 99, No. 4, 2004, pp. 719728.
H. W. Waclawiczek, F. Chmelizek, M. Heinerman, W. Pimpl, H. Kaindl, P. Sungler and O. Boeckl, “Laparostoma (Open Packing) in the Treatment Concept of Infected Pancreatic Necroses,” Wien Klin Wochenschr, Vol. 104, No. 15, 1992, pp. 443447.
G. Funariu, V. Bin?in?an, R. Seicean and R. Scurtu, “Surgical Treatment of Severe Acute Pancreatitis” Chirurgia Bucharest, Vol. 101, No. 6, 1990, pp. 599607.
E. L. Bradley, “A Clinically Based Classification System for Acute Pancreatitis: Summary of the International Symposium on Acute Pancreatitis,” Archives of Surgery, Vol. 128, No. 5, 1993, Atlanta, pp. 586590.
del C. C. Fernandez, D. W. Rattner, M. A. Makary, V. I. A, Mostafa, D. McGrath and A. L. Warshaw, “Debridement and Closed Packing for the Treatment of Necrotizing Pancreatitis,” Annals of Surgery, Vol. 228, No. 5, 1998, pp. 676684.
W. Uhl, A. Warshaw and C. Imrie, “IAP Guidelines for the Surgical Management of Acute Pancreatitis,” Pancreatology, 2002, Vol. 2, No. 6, pp. 565573.
S. Connor and J. P. Neoptolemos, “Surgery for Pancreatic Necrosis: ‘Whom, When and What’,” World Journal of Gastroenterology, Vol. 10, No. 12, 2004, pp. 16971698.
I. Popescu, “Management of the Severe Acute Pancreatitis,” Chirurgia, Vol. 101, 2006, pp. 225228.
G. Funariu, M. Suteu, G. Dindelegan, N. Maftei and R. Scurtu, “The Indications for Celiostomy in Acute Necrotizing Pancreatitis,” Chirurgia, 1990, Vol. 93, No. 6, pp. 395400.
A. Lepp?niemi, “Open Abdomen after Severe Acute Pancreatitis,” European Journal of Trauma and Emergency Surgery, 2008, Vol. 34, 1723.
G. Farkas, “Pancreatic Head Mass: How can we Treat it? Acute Pancreatitis: Surgical Treatment,” Journal of the Pancreas, Vol. 1, No. 3, 2000, pp. 138142.
L. Edward and E. L. III Bradley, “Open Packing in Infected Pancreatic Necrosis,” Digestive Surgery, Vol. 997, pp. 7781.
J. Lange, “Therapy of Acute Necrotizing Pancreatitis with Open Packing,” Digestive Surgery, 1994, Vol. 11, pp. 257260.
C. Bassi, G. Butturini, M. Falconi, R. Salvia, I. Frigerio, and P. Pederzoli, “Outcome of Open Necrosectomy in Acute Pancreatitis,” Pancreatology, 2003, Vol. 3, No. 2, pp. 128132.
T. Bruennler, J. Langgartner, S. Lang, C. E. Wrede, F. Klebl, S. Zierhut, S. Siebig, F. Mandraka, F. Rockmann, B. Salzberger, S. Feuerbach, J. Schoelmerich and O.W. Hamer, “Outcome of Patients with Acute, Necrotizing Pancreatitis Requiring DrainageDoes Drainage Size Matter?” World Journal of Gastroenterology, Vol. 14, No. 5, 2008, pp. 725730.
C. R. Carter, C. J. McKay and C. W. Imrie, “Percutaneous Necrosectomy and Sinus Tract Endoscopy in the Management of Infected Pancreatic Necrosis: An Initial Experience,” Annals of Surgery, Vol. 232, 2000, pp. 175180.