Minimally invasive approach in acute necrotizing pancreatitis: a strategy for a selected subgroup or a potential benefit for all? Dutch Acute Pancreatitis Study Group

2006 ◽  
Vol 18 (1) ◽  
pp. A2
Author(s):  
MGH Besselink ◽  
HC van Santvoort ◽  
TL Bollen ◽  
MS van Leeuwen ◽  
JS Lameris ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Minimally Invasive ◽  
Potential Benefit ◽  
Necrotizing Pancreatitis ◽  
Acute Necrotizing Pancreatitis ◽  
Study Group ◽  
Minimally Invasive Approach ◽  
Invasive Approach ◽  
Acute Necrotizing

scholarly journals Comparison of open pancreatic necrosectomy with step-up minimally invasive approach as surgical treatment of patients with acute necrotizing pancreatitis

2017 ◽  
Vol 4 (8) ◽  
pp. 2502
Author(s):  
Ihor V. Khomiak ◽  
Oleksandr V. Rotar ◽  
Ivan S. Tereshkevych ◽  
Vasyl I. Rotar ◽  
Andrii I. Khomiak ◽  
...  
Keyword(s):  
Invasive Surgery ◽  
Necrotizing Pancreatitis ◽  
Disease Onset ◽  
Acute Necrotizing Pancreatitis ◽  
Surgical Approaches ◽  
Control Group ◽  
Study Group ◽  
Invasive Approach ◽  
Number Of Patients ◽  
Acute Necrotizing

Background: Recent experimental and clinical researches improves our understanding of natural course of acute necrotizing pancreatitis and mechanisms of its complications development. Today there are no disagreements on the issue of timing and main indications for surgery of ANP, but different surgical approaches still exist.Methods: The analysis of treatment of 226 patients with acute necrotizing pancreatitis has been performed. The study group included 116 patients in whom consequently diapeutic methods, endoscopic and lumbotomic video-controlled pancreatic necrsequesterectomy, minilaparo and lumbotomy, in case of their insufficiency- “open” interventions on pancreas were applied. In 110 persons of the control group traditional surgical tactic with application of laparotomic procedures was used.Results: Sequential (step-up) implementation of mini-invasive surgery allowed to reduce the number of open wide operations by 3.4 times (p <0,05) and to postpone their performance: 85% of operations in the study group were performed after 4 weeks of the disease onset, in the control group only 33% (p <0,05). Compared with the control group the level of the first diagnosed OF after the surgery was significantly lower in patients undergoing preliminary mini-invasive surgery (12.5% versus 28.2%, p <0.05), the number of patients requiring prolonged intensive care after the surgery was significantly lower (17.5% versus. 38.2%, p <0.05). 4 patients of the study group died (versus 26 in the control group р<0,05).Conclusions: Application of step-up individualized approach in patients with acute necrotizing pancreatitis ensures a decrease in the number of laparotomic pancreatic necrosectomies and allows to postpone "open" operations for the period after the 4th week of disease onset which is accompanied by reduction of the incidence of postoperative organ failure and mortality.

The burden of acute pancreatitis and early experience of step-up approach for acute necrotizing pancreatitis at Military Hospital

2019 ◽  
Vol 22 (2) ◽  
pp. 11-17
Author(s):  
Sushil Bahadur Rawal ◽  
Uttam Laudari ◽  
Basanta Khatiwada ◽  
Anup Thapa ◽  
Manoj Kumar Jha ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Severe Acute Pancreatitis ◽  
Necrotizing Pancreatitis ◽  
Early Experience ◽  
Acute Necrotizing Pancreatitis ◽  
Military Hospital ◽  
Army Hospital ◽  
Acute Necrotizing ◽  
Hospital Resources ◽  
Open Necrosectomy

Introduction: Twenty-five percent of acute pancreatitis develops severe acute pancreatitis (SAP). SAP patients have prolonged hospitalization and require a substantial amount of manpower and hospital resources. The aim of this study was to give an insight into the burden of acute pancreatitis at a tertiary level military hospital and to share the experience of managing pancreatic necrosis with the application of the step-up approach. Methods: A prospective descriptive study of consecutive patients was conducted at Shree Birendra Army Hospital from 2017 June to 2017 November. Patients with a diagnosis of acute pancreatitis admitted were stratified according to severity as per Revised Atlanta classification 2012. Patients with acute necrotizing pancreatitis were enrolled for the step-up approach. Patient’s demography, baseline investigations, radiology, prognostic scoring scales and type of intervention were analyzed. The burden of severe acute pancreatitis at our center and the early experience of the step-up approach at our centre within the study period were studied. Results: Out of 35 five patients with acute pancreatitis, 7 (20%) subsequently developed severe acute pancreatitis. Among them, five patients subsequently developed necrotizing pancreatitis who were managed according to the step-up approach. Out of them, three patients subsequently underwent operative intervention in the form of minimally invasive procedures like percutaneous drain placement, laparoscopic necrosectomy, video-assisted retroperitoneal debridement, and open necrosectomy. Conclusion: Acute pancreatitis is a common presentation at our centre. The step-up approach in the management of acute necrotizing pancreatitis is a safe and feasible approach.

Percutaneous Endoscopic Step-Up Therapy Is an Effective Minimally Invasive Approach for Infected Necrotizing Pancreatitis

2019 ◽  
Vol 65 (2) ◽  
pp. 615-622 ◽  
Author(s):  
Saransh Jain ◽  
Rajesh Padhan ◽  
Sawan Bopanna ◽  
Sushil Kumar Jain ◽  
Rajan Dhingra ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Necrotizing Pancreatitis ◽  
Minimally Invasive Approach ◽  
Invasive Approach

scholarly journals ARROSIVE BLEEDING WITH PANCREATIC NECROSIS — TACTICAL APPROACHES

2020 ◽  
pp. 85-88 ◽  
Author(s):  
V. V. Mishchenko ◽  
P. I. Pustovoit ◽  
R. Yu. Vododyuk ◽  
V. V. Velichko ◽  
V. V. Goryachy
Keyword(s):  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Acute Necrotizing Pancreatitis ◽  
Stent Grafts ◽  
Invasive Treatment ◽  
Results Of Treatment ◽  
Hemorrhagic Complications ◽  
Necrotic Pancreatitis ◽  
Acute Necrotizing

Summary. The problem of hemorrhagic complications of destructive pancreatitis is relevant. The aim of the study was to study the frequency and sources of hemorrhagic complications in patients with pancreatic necrosis, to evaluate the tactics of diagnosis and the effectiveness of methods to stop bleeding. Materials and methods. A study of the results of treatment of 40 patients with acute necrotizing pancreatitis was conducted. Results and its discussion. In 67.5 % of patients with acute necrotizing pancreatitis, hemorrhagic complications in the form of arrosive bleeding were observed. A method of endovascular occlusion of vessels using Gianturco spirals or stent grafts to stop arrosive bleeding in acute necrotizing pancreatitis has been introduced in the clinic. In 37.0 % of cases, repeated signs of arrosive bleeding were observed. In acute necrotizing pancreatitis complicated by arrosive bleeding, mortality was 44.4 %. Conclusions. The main cause of hemorrhagic complications in acute necrotic pancreatitis is acute necrotic changes, during infection of which arrosia of adjacent vessels occurs. The predominant tactic in case of bleeding from the retroperitoneal space against the background of minimally invasive treatment is clamping of drains, endovascular hemostasis using Gianturco spirals or stent grafts and the use of hemostatic soluble gauze (hemostop). Mortality in the development of arrosive bleeding in acute necrotic pancreatitis is 44.4 %.

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.

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