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2006 Abstracts: Long Term Follow-up of Patients who survive an episode of Acute Necrotizing Pancreatitis (ANP)
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Long Term Follow-up of Patients who survive an episode of Acute Necrotizing Pancreatitis (ANP)
William H. Nealon, Taylor S. Riall; Surgery, University of Texas medical Branch, Galveston, TX

Background:Considerable attention has been paid to the issuessurrounding an episode of ANP. There have been few reports examining the long term outcomes in these patients.Objective:We aim to provide data regarding the natural course in patients who have survived an episode of ANP.Methods:Since 1985, patients who survived ANP and were followed for more than one year were included in our study.ANP was defined as more than 5 Ranson prognostic indicators,as stay of at least 5 days in the ICU and radiographic evidence of necrosis.Note was made of the measures required during the acute event.Patients were monitored for re-hospitalization,repeat episodesof acute pancreatitis(AP),need for operation,percutaneous or endoscopic procedures,persistent drainage after operation or nonoperative measures,pseudocyst,main pancreatic duct(MPD) injuries and need for insulin or enzymes.Results:We have followed 134 patients for a mean follow-up of 61 months.44 patients were transferred after their episode of ANP.Necrosectomy/debridement was performed in 64 patients. Percutaneous treatment was used in 56 patients including 24 of the necrosectomy patients.71 patients had gallstone AP.53 patients had an uncomplicated long term course. MPD in 42 of these 53 was normal in 38 and mild stricture iin 4.81 patients had a complicated course.77 required operation for pseudocyst (35/77)inflammatory mass or persistently draining fistula(37/77)and for recurrent AP with or without these other findings(57/77)Among the 134 survivors 79 became insulin dependent(24 after late surgery)There was one death in a late operated patient.MPD disruption,stricture or leak was seen in all 81 complicated patients.No repeat episodes of ANP was seen.No patient with gallstone AP had a repeat episode of AP in spite of a mean interval to cholecystectomy of 39.2 days.Conclusion:Survivors of ANP are at risk for subsequent complications primarily predicated upon MPD injuries.Operative management is often required and can be performed safely.


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