Improved Mortality in Necrotizing Pancreatitis with a Multidisciplinary Minimally Invasive Step-Up Approach: Comparison with a Modern Open Necrosectomy Cohort

2020 ◽  
Vol 230 (6) ◽  
pp. 873-883 ◽  
Author(s):  
Casey M. Luckhurst ◽  
Majed El Hechi ◽  
Ahmed E. Elsharkawy ◽  
Ahmed I. Eid ◽  
Lydia R. Maurer ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Necrotizing Pancreatitis ◽  
Open Necrosectomy

Retrospective Validation of an Algorithmic Treatment Pathway for Necrotizing Pancreatitis

2019 ◽  
Vol 85 (8) ◽  
pp. 840-847
Author(s):  
Ryan C. Pickens ◽  
Jesse K. Sulzer ◽  
Allyson Cochran ◽  
Dionisios Vrochides ◽  
John B. Martinie ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Necrotizing Pancreatitis ◽  
Laparoscopic Approach ◽  
High Volume ◽  
Evidence Based ◽  
Robot Assisted ◽  
Delayed Treatment ◽  
Open Necrosectomy

The role of surgical intervention for necrotizing pancreatitis has evolved; however, no widely accepted algorithm has been established to guide timing and optimal modality in the minimally invasive era. This study aimed to retrospectively validate an established institutional timing- and physiologic-based algorithm constructed from evidence-based guidelines in a high-volume hepatopancreatobiliary center. Patients with necrotizing pancreatitis requiring early (≤six weeks from symptom onset) or delayed (>six weeks) surgical intervention were reviewed over a four-year period (n = 100). Early intervention was provided through laparoscopic drain-guided retroperitoneal debridement (n = 15) after failed percutaneous drainage unless they required an emergent laparotomy (due to abdominal compartment syndrome, bowel necrosis/perforation, or hemorrhage) after which conservative, sequential open necrosectomy was performed (n = 47). Robot-assisted (n = 16) versus laparoscopic (n = 22) transgastric cystgastrostomy for the delayed management of walled-off pancreatic necrosis was compared, including patient factors, operative characteristics, and 90-day clinical outcomes. Major complications after early debridement were similarly high (open 25% and drain-guided 27%), yet 90-day mortality was low (open 8.5% and drain-guided 7.1%). Patient and operative characteristics and 90-day outcomes were statistically similar for robotic versus laparoscopic transgastric cystogastrostomy. Our evidence-based algorithm provides a stepwise approach for the management of necrotizing pancreatitis, emphasizing minimally invasive early and late interventions when feasible with low morbidity and mortality. Robot-assisted transgastric cystogastrostomy is an acceptable alternative to a laparoscopic approach for the delayed treatment of walled-off pancreatic necrosis.

Minimally Invasive Approach to Infected Pancreatic Necrosis

2017 ◽  
Author(s):  
Rachel J. Kwon
Keyword(s):  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Infected Pancreatic Necrosis ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Open Necrosectomy ◽  
Study Intervention ◽  
Landmark Study

This chapter provides a summary of a landmark study in abdominal surgery. Does a minimally invasive, “step-up” approach to necrotizing pancreatitis reduce mortality and major complications as compared to open necrosectomy? Starting with that question, it describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case involving a patient with infected pancreatic necrosis.

scholarly journals Comparison of Different Surgical Methods for Necrotizing Pancreatitis: A Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Jianguo Xiao ◽  
Xiaojiao Quan ◽  
Fang Liu ◽  
Wen Li
Keyword(s):  
Minimally Invasive Surgery ◽  
Treatment Group ◽  
Minimally Invasive ◽  
Invasive Surgery ◽  
Enterocutaneous Fistula ◽  
Pancreatic Insufficiency ◽  
Necrotizing Pancreatitis ◽  
Cutaneous Fistula ◽  
Abdominal Bleeding ◽  
Open Necrosectomy

Purpose: To compare the effectiveness and safety of three methods of open necrosectomy, minimally invasive surgery and endoscopic step-up approach for necrotizing pancreatitis.Methods: We searched Pubmed, Embase, ScienceDirect, and CNKI full text database (CNKI) (to December 25, 2019). RCT, prospective cohort study (PCS), and retrospective cohort study (RCS) comparing the effectiveness and safety of any two of above-mentioned three methods were included.Results: There was no significant difference in major complications or death, and mortality between the minimally invasive surgery treatment group and the endoscopic step-up approach treatment group (RR = 1.66, 95%CI: 0.83–3.33, P = 0.15; RR = 1.05, 95%CI: 0.59–1.86, P = 0.87); the incidence rate of new-onset multiple organ failure, enterocutaneous fistula, pancreatic-cutaneous fistula, intra-abdominal bleeding, and endocrine pancreatic insufficiency in the endoscopic step-up approach treatment group was significantly lower than minimally invasive surgery group (RR = 2.65, 95%CI: 1.10–6.36, P = 0.03; RR = 6.63, 95%CI: 1.59–27.60, P = 0.009; RR = 7.73, 95%CI: 3.00–19.89, P < 0.0001; RR = 1.91, 95%CI: 1.13–3.24, P = 0.02; RR = 1.83, 95%CI: 1.9–3.16, P = 0.02); hospital stay in the endoscopic step-up approach group was significantly shorter than minimally invasive surgical treatment group (MD = 11.26, 95%CI: 5.46–17.05, P = 0.0001). The incidence of pancreatic-cutaneous fistula in the endoscopic escalation step therapy group was significantly lower than that in the open necrosectomy group (RR = 0.11, 95%CI: 0.02–0.58, P = 0.009).Conclusion: Compared with minimally invasive surgery and open necrosectomy, although endoscopic step-up approach cannot reduce the main complications or death and mortality of patients, it can significantly reduce the incidence of some serious complications, such as pancreatic-cutaneous fistula, enterocutaneous fistula, intra-abdominal bleeding, endocrine pancreatic insufficiency, and can significantly shorten the patient's hospital stay.

475n Minimally Invasive Step-up Approach Versus Open Necrosectomy in Necrotizing Pancreatitis: A Randomized Controlled Multicenter Trial

2010 ◽  
Vol 138 (5) ◽  
pp. S-65-S-66 ◽  
Author(s):  
Hjalmar C. van Santvoort ◽  
Olaf J. Bakker ◽  
Marc G. Besselink ◽  
Hendrik S. Hofker ◽  
Marja A. Boermeester ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Necrotizing Pancreatitis ◽  
Multicenter Trial ◽  
Randomized Controlled ◽  
Open Necrosectomy

Strategic approach to minimally invasive necrosectomy for necrotizing pancreatitis: technique, complications and predictors of outcome

2021 ◽  
Author(s):  
Nihar Mohapatra ◽  
Shridhar V. Sasturkar ◽  
Sanyam Falari ◽  
Rommel Sandhyav ◽  
Niteen Kumar ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Necrotizing Pancreatitis ◽  
Predictors Of Outcome ◽  
Strategic Approach

scholarly journals Pancreatic window and open necrosectomy; a surgical alternative for walled-off pancreatic necrosis in a second level hospital in Mexico

2020 ◽  
Vol 8 (11) ◽  
pp. 4158
Author(s):  
Pedro A. Alvarado-Bahena ◽  
Enrique Chavez-Serna ◽  
Jonatan Salgado-Vives ◽  
Uraik F. Hernandez-Bustos ◽  
Dante A. Saldivar-Vera ◽  
...  
Keyword(s):  
Developing Countries ◽  
Acute Pancreatitis ◽  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Late Complication ◽  
Late Complications ◽  
Open Approach ◽  
Invasive Procedures ◽  
Open Necrosectomy ◽  
Level Hospital

Walled-off pancreatic necrosis is defined as a necrotic collection with a defined wall, which generally occurs in 15% of patients in the fourth week after acute pancreatitis. Actually, open surgery is reserved for selected cases, with minimally invasive treatments such as image-assisted percutaneous drainage or endoscopic ultrasound being the procedures of choice. However, in developing countries the open approach continues to be an effective therapeutic alternative. We present the case of a 47-year-old male patient with no significant history who developed severe acute pancreatitis secondary to hypertriglyceridemia and who later developed walled-off pancreatic necrosis as a late complication. As a treatment, a debridement of the necrotic tissue with marsupialization was performed using the bradley III technique, secondary to the procedure, a pancreatic fistula was developed. After 8 weeks of hospitalization, in which he had a favourable response to surgical treatment, with spontaneous closure of the fistula without complications. Surgical management of late complications of acute pancreatitis remains controversial. Although minimally invasive procedures are the first option nowadays, in developing countries, open necrosectomy remains a good option for the treatment of these types of complications.

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