Ten years of experience with transgastric necrosectomy for walled-off necrosis in acute pancreatitis.

INTRODUCTION: The aim of this study was to report our results with open transgastric necrosectomy for walled-off necrosis in acute pancreatitis over a period of ten years. METHODS: Patients operated at the department from 2003 until 2012 were studied retrospectively. RESULTS: A total of 50 patients had surgery. The median age was 55 years (range: 17-79 years). The presumed aetiologies were: gallstones (n = 28), alcohol (n = 8) and other causes (n = 14). The median preoperative stay at hospital was 50 days (range: 2-150 days). Bacterial culture from the necrotic tissue was positive in 26 patients (52%), negative in 15 patients (30%); and in nine patients, no information on this was available. In all, 22 patients (44%) had one or more incidents (i.e. abdominal compartment syndrome, bleeding, new abscess, pleural effusion or delayed gastric emptying) where additional invasive therapy was needed. Ten patients (20%) died during their admission to our department. In total, 18 (45%) patients developed late complications defined as endocrine and/or exocrine malfunction of the pancreas (diabetes (n = 10), exocrine insufficiency (n = 4), both diabetes and exocrine insufficiency (n = 4)). CONCLUSION: Acute pancreatitis with walled-off necrosis has a high mortality rate. Need for additional therapy following necrosectomy was associated with fatal outcome. Endocrine and exocrine insufficiency was often seen at follow-up. FUNDING: none. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency via Region of Southern Denmark (case no. 13/29319).