Closed management of pancreatic necrosis complicated by diffuse peritonitis

Abstract

AIM: To assess an efficiency of closed management of pancreatic necrosis complicated by widespread peritonitis by using of elective laparoscopic sanations with ultrasonic processing of an abdominal cavity and retroperitoneal space. MATERIAL AND METHODS: Treatment of 111 patients with pancreatic necrosis complicated by diffuse peritonitis was analyzed. Closed management was used in 41 patients (main group). Among them there were 12 patients who underwent laparoscopic sanation with ultrasonic cavitation of abdominal cavity, laparoscopic drainage of omental bag, US-assisted puncture drainage of retroperitoneal space and 29 patients after laparotomy followed by laparoscopic lavage and low-frequency ultrasound through retroperitoneal drains which were deployed during lumbotomy or under US control. Control group included 70 patients in whom open treatment of diffuse peritonitis was used (laparotomy, lumbotomy, omentobursostomy). Monitoring of hepatonephric dysfunction, endogenic intoxication was carried out. RESULTS: It was concluded that developed technique is associated with better clinical and laboratory data due to less surgical trauma and ultrasonic cavitation in early postoperative period. Rapid recovery of liver function, decrease of endogenic intoxication and mortality rate were observed. So, this method may be recommended for patients with pancreatic necrosis complicated by diffuse peritonitis.