open access

Vol 3, No 4 (2001)
Published online: 2002-04-25
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The "open abdomen" treatment of acute necrotic pancreatitis - nutritional support, management of infection, postoperative complications and infection

Jan Kalaciński, Tomasz Orawczyk, Krzysztof Kurczych, Paweł Ćwik, Mariusz Ciopała, Andrzej Wojdyło
Chirurgia Polska 2001;3(4):171-178.

open access

Vol 3, No 4 (2001)
Published online: 2002-04-25

Abstract

Introduction: The aim of surgery in acute, necrotic pancreatitis is the removal of the necrotic tissues and limitation of the inflammatory process. One of the basic operative procedures is "open abdomen" treatment.
Aim of this study: The authors present results of surgical ("open abdomen") and nutritional therapies in patients with severe acute pancreatitis.
Material and methods: 30 patients (16 M, 14 F, mean age 51.5), treated at the Department of General Surgery and the Intensive Care Unit from 1994 to 1999. The principal therapy used was: fluid i.v., electrolyte and protein supplementations, antibiotic, analgesic, antioxidant and antithrombotic drugs were applied simultaneously in all the patients. Additionally, twenty-three patients (76.6%) received parenteral and enteral nutrition. Postoperative complications, duration of hospitalisation and quality of life (according to Zubrod’s scale) were assessed. In-patients received nutritional therapy; energy expenditure, energy intake, duration of nutritional support and return to oral feeding were analysed.
Results: Mean duration of the hospitalisation was 45 days (from 27 to 95), 8 patients (26.6%) died. Sepsis was recognised in 12 patients (40%), renal failure in 15 (30%), cardio-respiratory insufficiency in 13 cases (43.3%). The following complications, related to surgical procedures, occurred: 12 cases of alimentary tract fistula (40%): small bowel fistula - 4 (13.3%), large bowel - 3 (10%), pancreatic - 5 (16.6%), bleeding from the injured vessels - 4 (13.3%); obstructive ileus - 2 (6.7%), wound infection - 20 (66.6%) and abdominal hernia -15 (50%). In the follow-up (5-25 months, mean 14) quality of life according to Zubrod’s scale was assessed: 8 patients received 0 points, 5 - 1 point, 5 - 2 points, 4 - 3 points (no patients had 4 or 5 points). Mean daily, actual energy expenditure was 3188.4 kcal (1303-5950), daily energy intake - 37.3 kcal/kg and protein intake 1.25 g/kg. Nutritional therapy was maintained for about 26 days (11-73); duration of the total parenteral nutrition was about 22 days (8-47) and enteral, which was applied for 3 to 24 (mean 10) days after operation, about 10 days (2-32).
Conclusions: 1) In municipal hospital circumstances, the treatment of complications related to "open abdomen" management in patients suffering from acute, necrotising pancreatitis is possible, but difficult - the experience of the surgical and anaesthesiological teams in the treatment of pancreatic diseases, especially appropriate management in postoperative period and acquaintance of the nutritional therapy, are required. 2) Nutritional support, particularly enteral nutrition, should be attempted in patients suffering from severe acute pancreatitis as soon as possible.

Abstract

Introduction: The aim of surgery in acute, necrotic pancreatitis is the removal of the necrotic tissues and limitation of the inflammatory process. One of the basic operative procedures is "open abdomen" treatment.
Aim of this study: The authors present results of surgical ("open abdomen") and nutritional therapies in patients with severe acute pancreatitis.
Material and methods: 30 patients (16 M, 14 F, mean age 51.5), treated at the Department of General Surgery and the Intensive Care Unit from 1994 to 1999. The principal therapy used was: fluid i.v., electrolyte and protein supplementations, antibiotic, analgesic, antioxidant and antithrombotic drugs were applied simultaneously in all the patients. Additionally, twenty-three patients (76.6%) received parenteral and enteral nutrition. Postoperative complications, duration of hospitalisation and quality of life (according to Zubrod’s scale) were assessed. In-patients received nutritional therapy; energy expenditure, energy intake, duration of nutritional support and return to oral feeding were analysed.
Results: Mean duration of the hospitalisation was 45 days (from 27 to 95), 8 patients (26.6%) died. Sepsis was recognised in 12 patients (40%), renal failure in 15 (30%), cardio-respiratory insufficiency in 13 cases (43.3%). The following complications, related to surgical procedures, occurred: 12 cases of alimentary tract fistula (40%): small bowel fistula - 4 (13.3%), large bowel - 3 (10%), pancreatic - 5 (16.6%), bleeding from the injured vessels - 4 (13.3%); obstructive ileus - 2 (6.7%), wound infection - 20 (66.6%) and abdominal hernia -15 (50%). In the follow-up (5-25 months, mean 14) quality of life according to Zubrod’s scale was assessed: 8 patients received 0 points, 5 - 1 point, 5 - 2 points, 4 - 3 points (no patients had 4 or 5 points). Mean daily, actual energy expenditure was 3188.4 kcal (1303-5950), daily energy intake - 37.3 kcal/kg and protein intake 1.25 g/kg. Nutritional therapy was maintained for about 26 days (11-73); duration of the total parenteral nutrition was about 22 days (8-47) and enteral, which was applied for 3 to 24 (mean 10) days after operation, about 10 days (2-32).
Conclusions: 1) In municipal hospital circumstances, the treatment of complications related to "open abdomen" management in patients suffering from acute, necrotising pancreatitis is possible, but difficult - the experience of the surgical and anaesthesiological teams in the treatment of pancreatic diseases, especially appropriate management in postoperative period and acquaintance of the nutritional therapy, are required. 2) Nutritional support, particularly enteral nutrition, should be attempted in patients suffering from severe acute pancreatitis as soon as possible.
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Keywords

acute pancreatitis; complication; surgery; laparostomy; nutrition

About this article
Title

The "open abdomen" treatment of acute necrotic pancreatitis - nutritional support, management of infection, postoperative complications and infection

Journal

Chirurgia Polska (Polish Surgery)

Issue

Vol 3, No 4 (2001)

Pages

171-178

Published online

2002-04-25

Bibliographic record

Chirurgia Polska 2001;3(4):171-178.

Keywords

acute pancreatitis
complication
surgery
laparostomy
nutrition

Authors

Jan Kalaciński
Tomasz Orawczyk
Krzysztof Kurczych
Paweł Ćwik
Mariusz Ciopała
Andrzej Wojdyło

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