Chirurgische Behandlung der akuten Pankreatitis

Hollender, L. F.; Marrie, A

doi:10.1007/978-3-662-00618-4_116

Cited by 6 publications

(8 citation statements)

References 12 publications

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“…In our series of 139 patients, mortality rate was significantly reduced by carrying out postoperative irrigation and sump drainage of the abdominal cavity. Similar positive effects of irrigation combined with sump drainage have been reported by Hollender [13], who observed a reduction of mortality rate from 80% with simple drainage of the peritoneal cavity, to 50% with irrigation and drainage, and to 33% when resection of the necrotic segments of the pancreas was added to irrigation and drainage, a figure comparable to our 33% mortality rate. Vankemmel [14] reported an overall mortality rate of 34% in 37 patients in whom necrosectomy was Combined with subsequent abdominal irrigation.…”

Section: Discussionsupporting

confidence: 91%

“…Until the beginning of the 1970's, our customary surgical procedure was limited to simple drainage of the pancreatic bed and revision of the biliary tract. Recently, following suggestions made by Hollender et al [8] and Kfimmerle et al [9], our surgical approach has become much more radical. In addition to cholecystectomy and drainage of the common bile duct which are necessary in patients with gallstones, we also carry out extensive necrosectomy.…”

Section: Surgical Therapymentioning

confidence: 97%

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Importance of peritoneal irrigation after surgical treatment of hemorrhagic, necrotizing pancreatitis

Gebhardt

Gall

1981

World j. surg.

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This is a report of 139 patients with hemorrhagic, necrotizing pancreatitis, 135 of whom were operated upon. The poorest results (mortality rate of 64%) were found in patients with total necrosis of the gland, while partial necrosis of the pancreas had a better outcome (33% mortality rate). The most favorable form of therapy was either local excision of necrotic pancreatic tissue (necrosectomy), or left resection of the pancreas, combined with postoperative irrigation and sump drainage of the peritoneal cavity. With this technique, the mortality rate of 72% seen with drainage of the peritoneal cavity alone was reduced to 33%.

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Section: Discussionsupporting

confidence: 91%

Section: Surgical Therapymentioning

confidence: 97%

Importance of peritoneal irrigation after surgical treatment of hemorrhagic, necrotizing pancreatitis

Gebhardt

Gall

1981

World j. surg.

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“…So berichteten Ku È mmerle et al [6], daû in ihrem Patientenkollektiv von den 20 konservativ behandelten Patienten mit einer schweren, nekrotisierenden Pankreatitis niemand u È berlebte. Ebenso wie andere Autoren [7] beschlossen sie, zuku È nftig fru È hzeitiger zu operieren. Es folgte eine Phase aggressiven operativen Vorgehens, in die auch der Berichtszeitraum der vorliegenden Untersuchung fa Èllt.…”

Section: Diskussionunclassified

Das Laparostoma in der chirurgischen Behandlung der hämorrhagisch-nekrotisierenden Pankreatits

Smektala¹

1999

Visc Med

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Treatment results of necrotising pancreatitis between 1982 and 1992 are reported. During the study period the management of necrotising pancreatitis was supplied by the laparostoma therapy. Within a standardised range of indications 118 patients with stage II and III of the disease were operated. The operative technique included distal pancreatectomy, necrectomy and debridement of the head of the pancreas. Among 72 patients (61.0%) a laparostoma treatment was applied, in 46 patients (39%) the abdominal cavity was closed post-operatively. A subsequent peritoneal lavage by stages was conducted within the laparostoma therapy group, in the other group the relaparotomy ensued from the clinical course. Although the degree of disease severity was more serious in the laparostoma group, the lethality rate could be reduced during the study period down to 21.4%. The lowest lethality rate was achieved by an operation after the 15th day of treatment.

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“…The lack of such a differentiation is an explanation for the discrepancies in, and the impossibility of comparing, the statistics of various studies reported in the literature. Since it is clinically often impossible to decide whether an edematous form (juice edema) or true autodigestion is present, an exploratory laparotomy is recommended in doubtful cases [9].…”

Section: Pathological Anatomy and Pathogenesismentioning

confidence: 99%

Pathological anatomy and pathogenesis of acute pancreatitis

Becker

1981

World j. surg.

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Acute pancreatitis involves autodigestion of the pancreas by its own secretions. The anatomical signal is tryptic necrosis. The so‐called edematous pancreatitis cannot be compared with acute tryptic pancreatitis as it is caused by swelling of the pancreas, with pancreatic juice in the parenchyma, but no necrosis occurs. The severity of acute pancreatitis is determined by the state of preservation of the pancreatic capsule. Three stages may exist: (a) the gland is enlarged with solitary areas of necrosis and the capsule is preserved; (b) confluent necrosis with necrosis of the lipid tissue occurs, but the capsule is preserved; and (c) necrosis extends into surrounding areas, especially into the omental bursa and the retroperitoneum, and the capsule is destroyed. Peritonitis, ileus, and pleural effusion may represent regional extension of acute pancreatitis. Shock is the most dangerous complication and is the most frequent cause of death.

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Chirurgische Behandlung der akuten Pankreatitis

Cited by 6 publications

References 12 publications

Importance of peritoneal irrigation after surgical treatment of hemorrhagic, necrotizing pancreatitis

Importance of peritoneal irrigation after surgical treatment of hemorrhagic, necrotizing pancreatitis

Das Laparostoma in der chirurgischen Behandlung der hämorrhagisch-nekrotisierenden Pankreatits

Pathological anatomy and pathogenesis of acute pancreatitis

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