scholarly journals Focused Open Necrosectomy as a Method of Treatment for Necrotising Pancreatitis – Complication Rates and Outcomes

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S888
Author(s):  
V. Fokins ◽  
H. Plaudis ◽  
K. Atstupens ◽  
K. Zeiza ◽  
M. Jusko
Keyword(s):  
Complication Rates ◽  
Necrotising Pancreatitis ◽  
Open Necrosectomy

scholarly journals P-P09 Salvage transgastric necrosectomy as a part of a step-up approach to managing acute necrotising pancreatitis

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Franko Shing Fun Ngan ◽  
Srishti Sarkar ◽  
Ali Arshad ◽  
Ben Maher ◽  
Nadeem Tehami ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pancreatic Tissue ◽  
Morbidity And Mortality ◽  
Endoscopic Drainage ◽  
High Morbidity ◽  
Internal Drainage ◽  
Invasive Approach ◽  
Endoscopic Necrosectomy ◽  
Necrotising Pancreatitis ◽  
Open Necrosectomy

Abstract Background The use of EUS (endoscopic ultrasound) guided drainage with endoscopic LAMS (lumen apposing metal stent) necrosectomy is an emerging treatment option for walled-off pancreatic necrosis (WOPN) secondary to acute severe pancreatitis. It can delay or remove the need for surgical necrosectomy, which can be associated with high morbidity and mortality. However, the endoscopic approach is not always successful due to a multitude of factors and salvage transgastric necrosectomy can be performed using the tract created by the LAMS to achieve internal drainage and remove necrotic pancreas.  Methods We describe our unit’s experience in managing WOPN in two patients. We suggest a treatment pathway of WOPN which includes a step-up approach including salvage transgastric necrosectomy in patients where multiple endoscopic necrosectomies and washouts have failed.  Results Two patients, aged 67 and 69, were admitted as intensive care transfers for gallstone and alcohol pancreatitis respectively. They underwent a step-up approach to treat their infected WOPN, starting with the deployment of LAMS and endoscopic necrosectomy. They both showed brief clinical improvement after repeated endoscopic necrosectomy but further imaging showed ongoing large collections that could not be treated endoscopically. Both patients underwent successful transgastric open necrosectomy where necrotic pancreatic tissue was accessed surgically through the already created cyst-gastrostomy. This had the advantage of internal drainage of the collection into the stomach without the need for external surgical drains. Conclusions The emphasis in the treatment of WOPN has shifted to minimally invasive percutaneous or endoscopic drainage modalities. Endoscopically inserted LAMS may not always achieve definitive drainage of the WOPN but should be employed in the first instance as they are associated with reduced morbidity and mortality compared to surgery. Ultimately, open necrosectomy with washout remains the definitive management strategy in the step-up approach. We believe that the trans-gastric open necrosectomy approach can be used successfully in patients where the minimally invasive approach has failed. 

scholarly journals Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients

Gut ◽  
2017 ◽  
pp. gutjnl-2016-313341 ◽  
Author(s):  
Sandra van Brunschot ◽  
Robbert A Hollemans ◽  
Olaf J Bakker ◽  
Marc G Besselink ◽  
Todd H Baron ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pooled Analysis ◽  
Individual Data ◽  
Necrotising Pancreatitis ◽  
Open Necrosectomy

scholarly journals Outcome of open necrosectomy versus minimally invasive retroperitoneal necrosectomy following percutaneous drainage in infected necrotising pancreatitis

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S220
Author(s):  
T. Karan ◽  
O.L. Naganath Babu ◽  
M. Srinivaasan ◽  
C. Kolandasamy ◽  
R. Prabhakaran ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Percutaneous Drainage ◽  
Necrotising Pancreatitis ◽  
Open Necrosectomy

Should Sequential Bilateral Total Knee Arthroplasty Be Limited to Patients Younger than 80? A Two-Arm Propensity Matched Study

2020 ◽  
Author(s):  
Antonio Klasan ◽  
Sven Edward Putnis ◽  
Wai Weng Yeo ◽  
Darli Myat ◽  
Brett Andrew Fritsch ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Selection ◽  
Knee Arthroplasty ◽  
Major Complication ◽  
The Elderly ◽  
Complication Rates ◽  
Bilateral Total Knee Arthroplasty ◽  
Proper Patient Selection ◽  
Patient Reported ◽  
Total Knee

AbstractDespite multiple studies, there remains a debate on the safety of bilateral total knee arthroplasty (BTKA) in the average age patient, with a paucity of data on the outcome of BTKA in an elderly population. This study included 89 patients aged 80 years and older undergoing sequential BTKA over 14 years were identified in a prospectively collected database. Two matched comparison groups were created: patients under 80 undergoing sequential BTKA and patients over 80 undergoing unilateral TKA (UTKA). An analysis of complications, mortality, revision, and patient-reported outcome measures was performed. Mean age of the elderly cohorts was similar: 82.6 for BTKA and 82.9 for UTKA. The average age BTKA cohort had a mean age of 69.1. Complication rates were higher in bilateral cohorts, more so in the elderly BTKA cohort. Pulmonary embolism (PE) was observed in bilateral cohorts only. In these patients, history of PE and ischemic heart disease was a strong predictive factor for developing a major complication. There was no difference in revision rates and infection rates between the three cohorts, and no difference in patient survivorship between the two elderly cohorts. Through the combination of low revision and high survivorship rates and comparable clinical outcomes, this article demonstrates that simultaneous BTKA is an appropriate option to consider for an elderly patient, with proper patient selection and perioperative management. The demonstrated risk groups show that emphasis on patient selection should be focused on medical history rather than chronological age.

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