Open and semiopen management

The open and semi-open techniques are based on primary surgical necrosectomy and frequent planned reoperations. After initial debridement, the involved necrotic area is packed with a ring of non-adherent gauze, the abdomen is left open, and the packing is changed every 24 to 48 h under sedation in the ICU. Other centers have introduced a semi-open procedure by inserting a synthetic mesh or a zipper in the abdominal fascia to allow easy re-entry for repeated lavage. Experienced centers have been able to reduce mortality rates to a favorable 15 per cent in patients with necrotizing pancreatitis. However, the schedule of repeated intra-abdominal manipulation results in a high incidence of bowel complications, pancreatic fistulas, and hemorrhage. Consequently, surgical treatment and the need for ICU therapy is often mandatory for several weeks.

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