The open packing of the lesser sac technique in infected severe acute pancreatitis

Abstract

The surgical technique we applied was the classical one with several improvements. Firstly, the timing of intervention is delayed until the occurrence of the clearly defined infected necrosis. Secondly, we limited the propagation of infection in submesocolic peritoneal cavity by creating this omental laparostomy with suturing the cutting edges of the gastrocolic ligament to the supra-umbilical anterior parietal peritoneum, near to the laparotomy, achieving the marsupialisation of the lesser sac. With this maneuver we protect submesocolic region by creating anomental wall. Another major advantage of our approach was the subsequent necrosectomy, daily during the first week, which was accompanied by the change of dressings. Simultaneously we carefully perform haemostasis in the areas of necrosectomy, even with the harmonic scalpel if the situation required it. Targeted antibiotherapy and antifungal medication was initiated according to the microbiological results. Considering the fact that the intensive care techniques are approximately the same in the last 10-15 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.