OPEN PANCREATIC NECROSECTOMY

       Pancreatic necrosectmy means removal of dead pancreatic tissue which happens following severe acute pancreatitis. Following any type of pancreatitis more than 80 percentage of patients recovers spontaneously. Remaining small group of patients develop complications like pancreatic necrosis, pseudocyst formation and pancreatic abscess. As long as no major systemic complications, these changes can be observed. But once the patient develops complications like septicaemia or organ failure with pancreatic necrosis then the patient may require necrosectomy. This procedure helps to reduce the infected material and so this helps to recover from systemic illness.

       Pancreatic necrosectomy can be done by laparoscopic technique or open method. Stable patients can undergo the procedure through laparoscopic technique. But unstable patients with multiorgan dysfunction patients may require open pancreatic necrosectomy.

       Here the procedure can be done through general anaesthesia or regional analgesia. The regional analgesia may be preferred, because of post operative pain relief and also for repeat procedure. Abdomen is opened through midline laparotomy. The gastrocolic ligament is opened and pancreas will be exposed. Depending on the area of necrosis, the dead tissue will be removed through finger dissection. The necrosed tissue is identified by the blackish colour of dead tissue and softer in consistency compared to normal pancreatic tissue. Extreme care must be taken to avoid injury to normal pancreatic tissue. If carefully performed then the possibility of bleeding is much less. Good wash will be given and two or more drainage tubes will be placed and then the abdomen will be closed.

       Sometime the patient may require the same procedure again which depends on the recovery of the patient.