Controlled Open Lesser Sac Drainage for Pancreatic Abscess

Abstract

Recent studies suggest that morbidity and mortality in patients with pancreatic abscess can be lessened if controlled open lesser sac drainage (COLD) is performed rather than traditional closed drainage (CD). To determine whether the outcome of patients treated by COLD was more favorable, 81 consecutive patients with pancreatic abscess managed surgically between 1966 and 1985 were studied. COLD, consisting of initial wide debridement of the abscess cavity, open packing, suction drainage, repeated operative pack changes, and lavage was used in 17 patients and CD in 64 patients. Age, sex, etiology of pancreatitis, and radiographic and laboratory findings were similar between treatment groups. However, the number of patients with overt systemic sepsis and those at increased risk of death based on Ranson signs associated with the predisposing episode of pancreatitis were greater in the COLD group than in the CD group (100% vs. 61%, and 92% vs. 44%, respectively; p ≤ 0.05 for both). Overall mortality in COLD and CD patients was 18% and 44%, respectively (p