Ten years of experience with transgastric necrosectomy for walled-off necrosis in acute pancreatitis

INTRODUCTION

The aim of this study was to report our results with open transgastric necrosectomy for walled-off necrosis in acute pancreatitis over a period of ten years.

METHODS

Patients operated at the department from 2003 until 2012 were studied retrospectively.

RESULTS

A total of 50 patients had surgery. The median age was 55 years (range: 17-79 years). The presumed aetiologies were: gallstones (n = 28), alcohol (n = 8) and other causes (n = 14). The median preoperative stay at hospital was 50 days (range: 2-150 days). Bacterial culture from the necrotic tissue was positive in 26 patients (52%), negative in 15 patients (30%); and in nine patients, no information on this was available. In all, 22 patients (44%) had one or more incidents (i.e. abdominal compartment syndrome, bleeding, new abscess, pleural effusion or delayed gastric emptying) where additional invasive therapy was needed. Ten patients (20%) died during their admission to our department. In total, 18 (45%) patients developed late complications defined as endocrine and/or exocrine malfunction of the pancreas (diabetes (n = 10), exocrine insufficiency (n = 4), both diabetes and exocrine insufficiency (n = 4)).

CONCLUSION

Acute pancreatitis with walled-off necrosis has a high mortality rate. Need for additional therapy following necrosectomy was associated with fatal outcome. Endocrine and exocrine insufficiency was often seen at follow-up.

FUNDING

none.

TRIAL REGISTRATION

The study was approved by the Danish Data Protection Agency via Region of Southern Denmark (case no. 13/29319).

Effect of intermediate care on mortality following emergency abdominal surgery. The InCare trial: study protocol, rationale and feasibility of a randomised multicentre trial

Background

Emergency abdominal surgery carries a 15% to 20% short-term mortality rate. Postoperative medical complications are strongly associated with increased mortality. Recent research suggests that timely recognition and effective management of complications may reduce mortality. The aim of the present trial is to evaluate the effect of postoperative intermediate care following emergency major abdominal surgery in high-risk patients.

Methods and design

The InCare trial is a randomised, parallel-group, non-blinded clinical trial with 1:1 allocation. Patients undergoing emergency laparotomy or laparoscopic surgery with a perioperative Acute Physiology and Chronic Health Evaluation II score of 10 or above, who are ready to be transferred to the surgical ward within 24 h of surgery are allocated to either intermediate care for 48 h, or surgical ward care. The primary outcome measure is all-cause 30-day mortality. We aim to enrol 400 patients in seven Danish hospitals. The sample size allows us to detect or refute a 34% relative risk reduction of mortality with 80% power.

Discussion

This trial evaluates the benefits and possible harm of intermediate care. The results may potentially influence the survival of many high-risk surgical patients. As a pioneer trial in the area, it will provide important data on the feasibility of future large-scale randomised clinical trials evaluating different levels of postoperative care.

Trial registration

Clinicaltrials.gov identifier: NCT01209663

Sodium Novobiocin: Stability Aspects

The stability of monosodium novobiocin has been examined. The solid antibiotic has been shown to be sensitive to light, but if properly protected, to be stable for a period of 2 years at 20°. In aqueous solution and suspension it is affected by increase of temperature, pH and certain heavy metals. Phosphate, and possibly sulphate, also cause decomposition. Concentrated solutions of novobiocin become coloured, particularly above 20° and in the presence of air. Light has little effect on potency but irradiation with ultra-violet light accelerates potency loss in solution. There appears to be no difference in the potency stability of three different batches of sodium novobiocin. Ultra-violet spectrophotometry cannot be used as a method of assay.