Fatal outcome with sterile form of pancreatic necrosis directly depends on the volume of necrosis and the total number of systemic complications in the patient. If the necrosis zone occupies more than 50% of the pancreatic parenchyma and the total number of systemic complications is equal to or exceeds three, then this condition of the patient provides an unfavorable outcome of the disease.
The question of the method for treating sterile pancreatic necrosis remains open to this day, as doctors have not come to a consensus, which therapy is more favorable: operative or conservative. Many surgeons offer to treat the sterile form with surgical intervention even at the early stages of the disease development independently, what scale of the gland is prone to necrosis. Others recommend surgery only with widespread necrosis, since in this case the risk of infection and the development of systemic complications increases. Supporters of the conservative method of treating a sterile disease, defending their method of treatment, cite the results of studies with a survival rate of patients of 100%.
Based on many years of experience in treating patients with sterile pancreatic necrosis, it can be said that the form of the disease itself can not serve as an indication for surgery, since conservative therapy is sufficient to treat such patients, provided there is no organ failure and a large number of systemic complications. However, if patients with such pancreatic necrosis have multiorgan or monoorganal insufficiency, then there are two conditions that will require surgical intervention for effective treatment of the patient.
Indications for surgical treatment of patients with sterile pancreatic necrosis:
- Complete conservative therapy does not help in the treatment of organ failure.
- On the background of sterile pancreatic necrosis, acute destructive pancreatitis of the fulminant form is rapidly progressing.
Advocates of the surgical intervention motivate their point of view by the fact that, in theory, non-secrecestrectomy can reduce the risk of an uninfected form of the disease becoming infected, as detritus, effusion and sequestrants are removed, that is, places where microorganisms usually start to multiply.
But since surgery at an early stage of this pancreonecrosis can lead to secondary infection due to invasive intervention, which is observed in more than 1/3 of patients, the survival rate of patients with this method of treatment is lower than with conservative therapy.