Published with the inputs from Dr Biju I K, Chief & Senior Consultant, Medical Gastroenterology And GI Endoscopy, Baby Memorial Hospital - Kozhikode

A pancreatic necrosectomy is an operation or minimally invasive procedure to removedead (necrotic) or infected tissue from the pancreas. It is usually required in people with severe acute necrotising pancreatitis, a serious condition in which part of the pancreas loses its blood supply and becomes infected or damaged.

The aims of the procedure are to

• Control infection and prevent sepsis
• Relieve abdominal pain and fever
•  Improve organ function
• Prevent life-threatening complications
• Preserve as much healthy pancreatic tissue as possible

Why might I need this procedure?

Most people with pancreatitis recover with medical treatment alone. However, a necrosectomy may be recommended if:

• There is infection within the dead pancreatic tissue
• You have persistent abdominal pain, fever or sepsis despite antibiotics and drainage
• Fluid collections or abscesses in or around the pancreas do not resolve with less invasive drainage
•  Other organs (such as kidneys or lungs) are affected by ongoing inflammation
• There is failure to improve after several weeks of intensive medical therapy

How is pancreatic necrosectomy performed?

It may be required if:

• Necrotizing pancreatitis develops with infection
• There is persistent abdominal pain, fever, or sepsis
• Fluid collections or abscesses do not improve with drainage
• Organ function is threatened due to severe inflammation

How is pancreatic necrosectomy performed?

There are three main techniques. The approach will depend on your general health, the extent and location of the necrosis, and the facilities available.

Anaesthesia and preparation

You will have the operation under general anaesthetic, so you will be asleep and feel no pain.

You may require pre-operative tests, such as blood work, CT or MRI scans, and infection screening.

You will be asked not to eat or drink for several hours before surgery. The anaesthetist and surgeon will discuss the procedure, potential risks, and obtain your consent.

Risks and  Possible Complications

All major surgery carries some risks, While every effort is made to reduce these, complications can include;

• Bleeding or need for blood transfusion
• Wound or intra-abdominal infection
• Leakage of pancreatic fluid or formation of a fistula
• Damage to nearby organs or blood vessels
• Temporary or permanent diabetes due to loss of pancreatic tissue
• Digestive difficulties requiring pancreatic enzyme supplements
•  Need for further procedures or re-operation

 Your surgical team will discuss your individual risk and answer any concerns

• You will usually be cared for in the Intensive Care Unit (ICU) or High-Dependency Unit (HDU) for close monitoring.
• Tubes and drains may be in place to remove fluid and monitor output.
• Pain relief will be provided by injection, drip, or patient-controlled analgesia (PCA).

 In hospital

• The average hospital stay is 2-4 weeks, depending on your recovery and the complexity of surgery.
• You will gradually begin oral or tube feeding as your bowel function returns.
• Physiotherapists and nurses will help you Io move and sit up safely to prevent complications.
• You will have regular scans and blood tests to assess healing

Many patients with necrotising pancreatitis are malnourished. Nutritional support may include:

• Oral diet as tolerated
• Nasogastric or jejunal tube feeding
• Occasionally intravenous (IV) nutrition

Your dietitian will work closely with you to restore nutrition and maintain weight. Full recovery can take several months. Fatigue is common but gradually improves with time.

Going home and follow-up

Before you go home, the team will ensure:

• Your wounds and drains (if any) are healing well
• You can eat and drink sufficiently
• Pain is well-controlled with tablets

Once Home

• Avoid heavy lifting or strenuous activity for at least 6 weeks
• Attend all follow-up appointments
• Contact the hospital if you develop fever, increasing pain, vomiting, or wound discharge

You will have follow-up scans and blood tests to monitor:

• Healing of the pancreas
• Blood sugar levels
• Digestive enzyme function

Some patients may require long-term enzyme supplements of diabetes medication if pancreatic function is 

Outcomes and prognosis

• In specialist centres, pancreatic necrosectomy has good success rates and significantly improves quality of life by controlling infection and preventing further complications.
  Your individual recovery will depend on:
  • The severity of pancreatitis
  • The extent of pancreatic tissue damage
  • Your overall health and nutritional status

Connect with Our Experts Today

Suppose you or a loved one is suffering from severe pancreatitis with complications. In that case, the Gastrointestinal Surgery & Critical Care Team at Baby Memorial Hospital (BMH) provides advanced pancreatic necrosectomy procedures with expert surgical care, minimally invasive options, and comprehensive post-operative support.

👉 Book an Appointment Online or visit BMH to consult our gastrointestinal specialists.