An "open-closed" technique for the treatment of necrotizing pancreatitis

Open packing or closed continuous irrigation of the lesser sac are used for the débridement of acute necrotizing pancreatitis. Multiple explorations are often required with either technique, and morbidity remains high. The authors describe a new method of treatment combining laparostoma and continuous lavage. This technique permits continuous atraumatic débridement of necrotic tissues with closed continuous lavage while maintaining a readily available laparostoma for further exploration. The exposure and débridement of the necrotic pancreatic bed and isolation of the bowel, with construction of a closed continuous irrigation system and laparostoma, are described in detail.