scholarly journals Management of Infected Pancreatic Necrosis—The “Step Up” Approach and Minimal Access Retroperitoneal Pancreatic Necrosectomy

2014 ◽  
Vol 77 (S1) ◽  
pp. 125-127 ◽  
Author(s):  
B. Joseph John ◽  
S. Swaminathan ◽  
L. VenkataKrishnan ◽  
G. S. Singh ◽  
G. Krishnaveni ◽  
...  
Keyword(s):  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Minimal Access ◽  
Pancreatic Necrosectomy

scholarly journals A rare case of emphysematous pancreatitis: managing a killer without the knife

2020 ◽  
Vol 2020 (6) ◽  
Author(s):  
Daniel Page ◽  
Sujith Ratnayake
Keyword(s):  
Acute Pancreatitis ◽  
High Mortality ◽  
Conservative Management ◽  
Rare Case ◽  
Pancreatic Necrosis ◽  
Case Reports ◽  
Small Body ◽  
Severe Complication ◽  
Infected Pancreatic Necrosis ◽  
Pancreatic Necrosectomy

Abstract Emphysematous pancreatitis (EP) is a rare and severe complication of acute pancreatitis carrying a high mortality with only a handful of case reports and small studies reporting these cases and their management. The presence of emphysematous pancreatitis is often indicative of infected pancreatic necrosis with the mainstay of treatment being pancreatic necrosectomy; however there are cases where it may be appropriate to have a trial of conservative management, and there is a small body of evidence to support this. This paper describes a case of an 87-year-old male with acute emphysematous pancreatitis successfully managed with conservative cares.

scholarly journals Two port laparoscopic retroperitoneal pancreatic necrosectomy: improvement in morbidity and mortality with a less invasive approach

2021 ◽  
Vol 8 (5) ◽  
pp. 1501
Author(s):  
Vinay H. G. ◽  
Ramesh Reddy G. ◽  
Shwetha Chandra R. ◽  
Merin Mary ◽  
Kiran Kumar
Keyword(s):  
Pancreatic Necrosis ◽  
Surgical Care ◽  
Invasive Procedure ◽  
Minimal Invasive ◽  
Infected Pancreatic Necrosis ◽  
Morbidity And Mortality ◽  
High Rate ◽  
Morbidity Rate ◽  
Invasive Approach ◽  
Pancreatic Necrosectomy

Background: Severe pancreatitis is associated with a high rate of mortality even with advanced surgical care and practices worldwide. Morbidity and mortality rates are much higher in the presence of infected pancreatic necrosis. From open necrosectomy, simple percutaneous drainage or one of several minimal access approaches, the question of optimal or best treatment is yet debatable. Step-up approach is currently practised by many physicians. We describe our technique of early drainage by minimal invasive two-port laparoscopic retroperitoneal pancreatic necrosectomy in our centre.Methods: Thirteen consecutive patients with proven infected pancreatic necrosis were treated by 2P-LRPN over a two-year period in the setting of a teaching hospital. The median patient age was 44 years (range: 28-66 years) and 10 of the patients were male.Results: The median time to discharge following the procedure of 14 days (range: 08-21 days). There was no mortality and the morbidity rate was 37%, consisting mainly of pancreatic fistula (37%).Conclusions: Two-port laparoscopic retroperitoneal pancreatic necrosectomy is an effective and minimally invasive procedure which had better outcomes with improved patient morbidity, shorter hospital stay and lesser complication rate. Early intervention with necrosectomy has better patient compliance.

scholarly journals Surgery in the Treatment of Acute Pancreatitis Minimal Access Pancreatic Necrosectomy

2005 ◽  
Vol 94 (2) ◽  
pp. 135-142 ◽  
Author(s):  
S. Connor ◽  
M. G. T. Raraty ◽  
N. Howes ◽  
J. Evans ◽  
P. Ghaneh ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Mortality Rate ◽  
Open Surgery ◽  
Pancreatic Necrosis ◽  
Statistical Significance ◽  
Infected Pancreatic Necrosis ◽  
Current Evidence ◽  
Minimal Access ◽  
Randomised Controlled ◽  
Invasive Techniques

Between 5% and 10% of patients with acute pancreatitis will develop infected pancreatic necrosis. Traditional open surgery for this condition carries a mortality rate of up to 50%, and therefore a number of less invasive techniques have been developed, including radiological drainage and a minimal access retroperitoneal approach. No randomised controlled trials have been published which compare these techniques. Indications for minimal access surgery are the same as for open surgery, i.e. infected pancreatic necrosis or failure to improve with extensive sterile necrosis. Access is obtained to the pancreatic necrosis via the left loin and necrosectomy performed using an operating nephroscope, and this often requires several procedures to remove all necrotic tissue. The cavity is continuously irrigated on the ward in between procedures. The results of this approach are encouraging, with less systemic upset to the patient, a lower incidence of post-operative organ failure when compared with open surgery, and a reduced requirement for ITU support. There is also a trend towards a lower mortality rate, although this does not reach statistical significance on the data published so far. Current evidence suggests that a minimal access approach to pancreatic necrosis is feasible, well tolerated and beneficial for the patient when compared with open surgery.

scholarly journals Management of necrotizing pancreatitis and its outcome in a secondary healthcare institution

2017 ◽  
Vol 4 (3) ◽  
pp. 1049 ◽  
Author(s):  
Tanweer Karim ◽  
Vinod Kumar ◽  
Vivek Kumar Katiyar ◽  
Subhash K.
Keyword(s):  
Clinical Judgment ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Operating Time ◽  
Surgical Techniques ◽  
Infected Pancreatic Necrosis ◽  
Minimal Access ◽  
Significant Difference ◽  
Surgical Conditions ◽  
Laparoscopic Techniques

Background: Surgical debridement is the “gold standard” for infected pancreatic necrosis. Advances in imaging methods and minimal access techniques have changed the management of many surgical conditions and even infected pancreatic necrosis has successfully been treated in selected patients. However, technical advances don’t obviate sound clinical judgment. Aim was to consider recent advances in minimal access surgery, this article retrospectively analyses the role of open surgery and laparoscopic techniques in the management of necrotizing pancreatitis.Methods: A retrospective study of 30 cases of pancreatic necrosectomy admitted and managed during 2012-2016 was carried out and compared with results available in the existing literature.Results: Out of 30 cases, 20 were men and 10 were women. Patients' age ranged from 23 to 70 years (mean age - 49.8 years). The mean operating time was 103.8 min (range, 60-120 min). Timing of necrosectomy was 21-32 days (average - 25.5 days). The average duration of hospital stay after the procedure was 17.4 days (range, 10-21 days).Conclusions: Comparative analysis of results of different surgical techniques reveals that there is no significant difference in terms of mortality. However, overall rate of complications and failure (inadequate debridement and drainage) are still higher with minimally invasive techniques.

scholarly journals Retroperitoneoscopic Pancreatic Necrosectomy: Taming the Relentless March of the Great Marauder

2020 ◽  
Vol 6 (02) ◽  
pp. 65-69
Author(s):  
Yash Rohatgi ◽  
Abhijit Joshi
Keyword(s):  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Alcoholic Pancreatitis ◽  
Pancreatic Necrosectomy ◽  
Acute Alcoholic Pancreatitis

AbstractWe hereby report a case of a 35-year-old male who presented to us with infected pancreatic necrosis, 4 weeks after an episode of acute alcoholic pancreatitis. Imaging investigations showed a predominantly left-sided pancreatic and peripancreatic infected collection. This case was managed successfully in a single sitting by retroperitoneoscopic intervention.

Management and Spectrum of Complications in Patients Undergoing Surgical Debridement for Pancreatic Necrosis

2008 ◽  
Vol 74 (11) ◽  
pp. 1050-1056 ◽  
Author(s):  
T. Peter Kingham ◽  
Peter Shamamian
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Percutaneous Catheter Drainage ◽  
Pancreatic Necrosectomy ◽  
Postoperative Intensive Care ◽  
Apache Iii

Patients who undergo pancreatic necrosectomy frequently develop complications and often have high mortality rates. These patients are best cared for at specialized centers to minimize morbidity, manage complex complications, and reduce mortality. We present a review of our experience and describe the spectrum of complications encountered in managing of these difficult patients. A registry of patients undergoing pancreatic necrosectomy during a 7-year period was analyzed for preoperative clinical scoring systems (Acute Physiology and Chronic Health Evaluation [APACHE] II and APACHE III scores), patient characteristics related to necrosectomy, and morbidity and mortality. Twenty-nine patients underwent necrosectomy. Indications for surgery were consistent with those previously described. There were 27 complications in 22 patients. Sixteen complications were early (less than 3 weeks after surgery) and 14 were late. The mortality rate was 14 per cent. All deaths were in patients transferred from outside institutions, some after extended time periods. Temporary percutaneous catheter drainage of abscesses before transfer and definitive surgery appeared to reduce mortality in transferred patients. There was a statistically significant correlation between mean maximal preoperative APACHE III score, but not APACHE II score, and the number of postoperative intensive care unit days (rho = 0.52, P = 0.004). We describe our experience managing patients with infected pancreatic necrosis that required operative necrosectomy. We found that more severely ill patients (higher APACHE III scores) had longer intensive care unit stays, but the initial severity of their illness did not increase mortality. If patients with infected pancreatic necrosis are referred to specialized centers, preoperative pre-transfer percutaneous drainage may serve to temporarily control sepsis.

Sign in / Sign up

Export Citation Format

Share Document