One-Step verse Step-Up Laparoscopic-Assisted Necrosectomy for Infected Pancreatic Necrosis

2019 ◽  
Vol 37 (3) ◽  
pp. 211-219 ◽  
Author(s):  
Feng Cao ◽  
Ning Duan ◽  
Chongchong Gao ◽  
Ang Li ◽  
Fei Li
Keyword(s):  
Hospital Stay ◽  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Endoscopic Drainage ◽  
Reactive Protein ◽  
Total Hospital Stay ◽  
Significant Difference ◽  
Area Under Roc Curve ◽  
One Step ◽  
Laparoscopic Assisted

Background: Percutaneous or endoscopic drainage was usually performed as the first step in step-up approach for infected pancreatic necrosis (IPN). However, drainage was unnecessary or unavailable in some patients. Objective: To estimate the safety and effect of one-step laparoscopic-assisted necrosectomy in IPN patients. Methods: A retrospective analysis of IPN patients received surgical therapy in our center between January 2015 and December 2017 was performed. Patients were assigned to either one-step or step-up groups according to the received therapeutic approach. Incidence of complications, death, total number of interventions, and total hospital stay were compared. Logistic regression and nomogram were used to explore the risk factors and probability for patients undergoing interventions ≥3 times. Results: There were 45 and 49 patients included in one-step and step-up groups, respectively. No significant difference between groups in terms of new organ failure (14.29 vs. 14.33%, p = 0.832), death (8.89 vs.8.17%, p = 0.949), and long-term complications (18.37 vs. 15.56%, p = 0.717). However, the number of interventions in one-step group was significantly less than in step-up group with shorter hospital stay. After multivariate analysis, C-reactive protein, interleukin-6, and surgical approach were independent predicators for patients undergoing interventions ≥3. A nomogram was built with area under ROC curve 0.891. Conclusion: Compared with step-up approach, one-step surgery was safe and effective in selected IPN patients with less interventions and shorter hospital stay.

scholarly journals Advanced technologies for treatment of infected pancreatic necrosis: differentiated approach

2020 ◽  
Vol 25 (1) ◽  
pp. 69-78
Author(s):  
E. A. Gallyamov ◽  
M. A. Agapov ◽  
O. E. Lutsevich ◽  
V. V. Kakotkin
Keyword(s):  
Surgical Approach ◽  
Pancreatic Necrosis ◽  
Medical Science ◽  
Main Idea ◽  
Infected Pancreatic Necrosis ◽  
Surgical Approaches ◽  
Endoscopic Drainage ◽  
Main Task ◽  
Minimal Damage ◽  
Key Steps

This work is based on analysis of publications devoted to the problem of surgical approach to treatment of acute pancreatitis over the last 30 years. The main aim of this review is to identify the key steps of evolution of surgical approach to treatment of infected pancreatic necrosis and also to determine the most promising approach among existing methods. The analysis of the most modern clinical recommendations adopted in different countries of the world, as well as the search for such problems, the solution of which will be the main task of world medical science in the near future, is carried out. It has been established that medical communities of different countries give preference to minimally invasive methods of debridement: percutaneous and transluminal endoscopic drainage. According to the most advanced recommendations, the method of choice for surgical treatment of infected pancreatic necrosis is transluminal endoscopic drainage, with inefficiency – percutaneous puncture drainage. The main idea that defines the search vector for treatment methods for the disease is the recognition of the fact that all surgical approaches are aimed at achieving one goal – removing the maximum possible volume of necrotic masses with minimal damage to surrounding tissues. Only a method that satisfies both requirements can be recognized as leading.

Laparoscopic assisted percutaneous drainage of infected pancreatic necrosis

2001 ◽  
Vol 15 (7) ◽  
pp. 677-682 ◽  
Author(s):  
K.D. Horvath ◽  
L.S. Kao ◽  
A. Ali ◽  
K.L. Wherry ◽  
C.A. Pellegrini ◽  
...  
Keyword(s):  
Percutaneous Drainage ◽  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Laparoscopic Assisted

A technique for laparoscopic-assisted percutaneous drainage of infected pancreatic necrosis and pancreatic abscess

2001 ◽  
Vol 15 (10) ◽  
pp. 1221-1225 ◽  
Author(s):  
K.D. Horvath ◽  
L.S. Kao ◽  
K.L. Wherry ◽  
C.A. Pellegrini ◽  
M.N. Sinanan
Keyword(s):  
Percutaneous Drainage ◽  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Pancreatic Abscess ◽  
Laparoscopic Assisted

scholarly journals Management of infected pancreatic necrosis: state of the art

2017 ◽  
Vol 44 (5) ◽  
pp. 521-529 ◽  
Author(s):  
Roberto Rasslan ◽  
Fernando da Costa Ferreira Novo ◽  
Alberto Bitran ◽  
Edivaldo Massazo Utiyama ◽  
Samir Rasslan
Keyword(s):  
Pancreatic Necrosis ◽  
Clinical Course ◽  
State Of The Art ◽  
Infected Pancreatic Necrosis ◽  
Endoscopic Drainage ◽  
Infected Necrosis ◽  
Current State ◽  
Organic Dysfunction ◽  
Open Necrosectomy ◽  
Diagnosis Of Infection

ABSTRACT Pancreatic necrosis occurs in 15% of acute pancreatitis. The presence of infection is the most important factor in the evolution of pancreatitis. The diagnosis of infection is still challenging. Mortality in infected necrosis is 20%; in the presence of organic dysfunction, mortality reaches 60%. In the last three decades, there has been a real revolution in the treatment of infected pancreatic necrosis. However, the challenges persist and there are many unsolved questions: antibiotic treatment alone, tomography-guided percutaneous drainage, endoscopic drainage, video-assisted extraperitoneal debridement, extraperitoneal access, open necrosectomy? A step up approach has been proposed, beginning with less invasive procedures and reserving the operative intervention for patients in which the previous procedure did not solve the problem definitively. Indication and timing of the intervention should be determined by the clinical course. Ideally, the intervention should be done only after the fourth week of evolution, when it is observed a better delimitation of necrosis. Treatment should be individualized. There is no procedure that should be the first and best option for all patients. The objective of this work is to critically review the current state of the art of the treatment of infected pancreatic necrosis.

scholarly journals CT-derived sarcopenia should not preclude surgical stabilization of traumatic rib fractures

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Derrick A. Doolittle ◽  
Matthew C. Hernandez ◽  
Francis I. Baffour ◽  
Michael R. Moynagh ◽  
Naoki Takahashi ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Hospital Stay ◽  
Frailty Index ◽  
Rib Fractures ◽  
Total Hospital ◽  
Skeletal Muscle Index ◽  
Icu Stay ◽  
Total Hospital Stay ◽  
Significant Difference ◽  
Considerable Morbidity

Abstract Background Rib fractures are associated with considerable morbidity and mortality. Surgical stabilization of rib fractures (SSRF) can be performed to mitigate complications. Sarcopenia is in general known to be associated with poor clinical outcomes. We investigated if sarcopenia impacted number of days of mechanical ventilation, intensive care unit (ICU) stay, and total hospital stay in patients who underwent SSRF. Methods A retrospective single institutional review was performed including patients who underwent SSRF (2009–2017). Skeletal muscle index (SMI) was semiautomatically calculated at the L3 spinal level on computed tomography (CT) images and normalized by patient height. Sarcopenia was defined as SMI < 55 cm2/m2 in males and < 39 cm2/m2 in females. Demographics, operative details, and postoperative outcomes were reviewed. Univariate and multivariate analyses were performed. Results Of 238 patients, 88 (36.9%) had sarcopenia. There was no significant difference in number of days of mechanical ventilation (2.8 ± 4.9 versus 3.1 ± 4.3, p = 0.304), ICU stay (5.9 ± 6.5 versus 4.9 ± 5.7 days, p = 0.146), or total hospital stay (13.3 ± 7.2 versus 12.9 ± 8.2 days, p = 0.183) between sarcopenic and nonsarcopenic patients. Sarcopenic patients demonstrated increased modified frailty index scores (1.5 ± 1.1 versus 0.9 ± 0.9, p < 0.001) compared to nonsarcopenic patients. Conclusions For patients who underwent SSRF for rib fractures, sarcopenia did not increase the number of days of mechanical ventilation, ICU stay, or total hospital stay. Sarcopenia should not preclude the utilization of SSRF in these patients.

scholarly journals Serum triglyceride level: a predictor of complications and outcomes in acute pancreatitis?

2019 ◽  
Vol 6 (4) ◽  
pp. 1343
Author(s):  
B. N. Anandaravi ◽  
L. Kalavathi
Keyword(s):  
Acute Kidney Injury ◽  
Acute Pancreatitis ◽  
Pleural Effusion ◽  
Hospital Stay ◽  
Triglyceride Level ◽  
Pancreatic Necrosis ◽  
Serum Triglyceride ◽  
Kidney Injury ◽  
Systemic Complications ◽  
Significant Difference

Background: The aims and objectives were to analyse the influence of elevated triglyceride level in acute pancreatitis so the ability to predict the severity of acute pancreatitis can help identify the patients at increased risk of morbidity and mortality, therefore to make an early decision to triage these patients and treat accordingly.Methods: An observational study was undertaken over a span of 6 months from January 2018 to June 2018 in K.R Hospital, Mysore, Karnataka, India. 50 Patients admitted with the diagnosis of acute pancreatitis, who had serum triglyceride levels measured within the first 24 hrs of admission, were divided into 2 groups. The study group consisted of patients with a triglyceride level ≥200 mg/dl (group 2) and the control group consisted of triglyceride level of ≤ 200 mg/dl (group 1). We collected the detailed history, data of laboratory values, incidence of complications like pleural effusion, acute kidney injury, pancreatic necrosis, shock, admission to ICU, length of total hospital stay and death.Results: A total of fifty patients were included in the study out of which 42 patients had triglycerides of less than 200 mg/dl and 8 patients had triglycerides of more than 200 mg/dl. There was no significant difference in the incidence of pleural effusion and shock but there was significant difference in the incidence of acute kidney injury, pancreatic necrosis and Intensive care unit stay between the two groups.Conclusions: A triglyceride level of more than 200 mg/dl on admission in acute pancreatitisis is an independent predictor of developing local and systemic complications, hospital stay, admission to ICU and death. 

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 Direct Endoscopic Necrosectomy: Timing and Technique

Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1305
Author(s):  
Sergio Pinto ◽  
Saverio Bellizzi ◽  
Roberta Badas ◽  
Maria Laura Canfora ◽  
Erica Loddo ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Clinical Outcome ◽  
Adverse Events ◽  
Hospital Stay ◽  
Pancreatic Necrosis ◽  
Metal Stents ◽  
Endoscopic Drainage ◽  
Endoscopic Necrosectomy ◽  
Interventional Techniques ◽  
Local Complications

Walled-off pancreatic necrosis (WOPN) is one of the local complications of acute pancreatitis (AP). Several interventional techniques have been developed over the last few years. The purpose of this narrative review is to explore such methodologies, with specific focus on endoscopic drainage and direct endoscopic necrosectomy (DEN), through evaluation of their indications and timing for intervention. Findings indicated how, after the introduction of lumen-apposing metal stents (LAMS), DEN is becoming the favorite technique to treat WOPN, especially when large solid debris or infection are present. Additionally, DEN is associated with a lower adverse events rate and hospital stay, and with improved clinical outcome.

scholarly journals Proton Pump Inhibitors Were Associated With Reduced Pseudocysts in Acute Pancreatitis: A Multicenter Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Shengyu Zhang ◽  
Ziying Han ◽  
Yuelun Zhang ◽  
Xiaomao Gao ◽  
Shicheng Zheng ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Cohort Study ◽  
Hospital Stay ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Control Group ◽  
Total Hospital ◽  
Total Hospital Stay ◽  
Study Results ◽  
Significant Difference

Background: Acute pancreatitis (AP) is a systemic inflammatory disorder with a wide spectrum of clinical symptoms that can range from mild to severe. Previous preclinical study results suggest that proton pump inhibitors (PPIs) can inhibit exocrine pancreatic secretion and exert anti-inflammatory properties, which might in turn improve the outcome of AP.Aim: We conducted this multicenter, retrospective cohort study to investigate the potential effects of PPIs on the mortality, and total duration of hospital stay and local complication occurrence of patients with AP.Methods: A total of 858 patients with AP were included. All patients presented to the hospital within 48 h of symptom onset and were divided into the following two groups: patients who were treated with PPIs (n = 684) and those not treated with PPIs (n = 174). We used propensity score matching (PSM) analysis to reduce confounding bias before comparing the outcomes between the two groups.Results: Before PSM analysis, there were significant differences in a number of parameters between the two groups, including age, sex, hematocrit, blood urea nitrogen, peritonitis signs, Ranson’s score, and Acute Physiology Chronic Health Evaluation II score and organ failure occurrence. Before PSM, the PPIs group had a higher rate of mortality than the control group [RR = 1.065; 95% confidence ratio (CI) 1.045–1.086; p = 0.001]. After PSM, there was no significant difference in mortality (RR = 1.009; 95% CI, 0.999–1.019; p = 0.554) or total hospital stay (p = 0.856), although the PPIs group had a lower occurrence of pancreatic pseudocyst (RR = 0.416; 95% CI 0.221–0.780; p = 0.005).Conclusion: This study showed that PPIs therapy was not associated with reduced mortality or total hospital stay, but was associated with a reduction in the occurrence of pseudocysts in patients with acute pancreatitis.

scholarly journals A comparative study of interval cholecystectomy and early cholecystectomy in acute cholecystitis

2020 ◽  
Vol 7 (5) ◽  
pp. 1419
Author(s):  
Gursimranjit Singh ◽  
Rana Ranjit Singh ◽  
Darpan Bansal
Keyword(s):  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Early Surgery ◽  
Total Hospital ◽  
Total Cost ◽  
Early Cholecystectomy ◽  
Total Hospital Stay ◽  
Significant Difference ◽  
Delayed Group ◽  
Day By Day

Background: In the whole world including India, the incidence of acute cholecystitis is increasing day by day. Gall stones are the most common cause of acute cholecystitis in 90-95% of the cases. The management of acute cholecystitis was conservative earlier but now there are studies recommending early surgery as the treatment of choice.Methods: Our study was conducted on 60 patients divided into two groups of 30 each to compare the results of early surgery with the delayed surgery.Results: The overall post-operative complication rate was same in both the groups but there was significant difference in the total hospital stay and total cost of the therapy in both the groups. The average total hospital stay in early group was 6.50±4.44 days and in delayed group was 10.80±5.55 days without including the number of days in non-operating admission.Conclusions: So, early cholecystectomy was found to be more economical with less total hospital stay and less total cost of the therapy than interval cholecystectomy in acute cholecystitis. 

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