A 20-year experience in surgical management of acute necrotizing pancreatitis

From 1974 to 1994, 243 patients with acute necrotizing pancreatitis (ANP) proved by operation or CT scanning system were treated. The overall survival rate was 70.4%. In 1974-1987, the resection of necrosis was radical and as early as possible, and the main type of operation was subtotal pancreatectomy. The survival rate in this period was 61.3% (49/80). In 1988-1991, the treatment was changed into "individualization" i.e. for sterile pancreatic necrosis, conservative treatment was setected while infected pancreatic necrosis, necrosectomy was performed early. In this period, the survival rate of conservative treatment was 85.7% (6/7) and that of operative treatment 67.1%. The overall survival rate in was 68.5% (63/92). In 1991-1994, we insisted on late operation for the patients with necrosis and comprehensive management for all the patients with ANP. The survival rate of conservative treatment in this period was 100% (11/11) and that of operative treatment 80% (48/60). The overall survival rate was 83.1% (59/71). We conclude that comprehensive management combined with late operation for the patients with necrosis infected is a better strategy for the treatment of ANP.