scholarly journals The Evolving Management of Infected Pancreatic Necrosis

2012 ◽  
Vol 78 (10) ◽  
pp. 1151-1155 ◽  
Author(s):  
Graham Donald ◽  
Timothy Donahue ◽  
Howard A. Reber ◽  
O. Joe Hines
Keyword(s):  
Early Intervention ◽  
Retrospective Review ◽  
Percutaneous Drainage ◽  
Therapeutic Strategy ◽  
Pancreatic Necrosis ◽  
Mortality Rates ◽  
Infected Pancreatic Necrosis ◽  
Intravenous Antibiotics ◽  
Operative Debridement ◽  
Mean Time

Management of infected pancreatic necrosis (IPN) has for decades been based on early operative débridement. This approach is associated with mortality rates as high as 58 per cent. Recently, the care of these patients has evolved and emphasizes delayed operation and early intervention with percutaneous drainage. In 2002, we began to incorporate these new principles for the treatment of IPN and herein characterize the recent UCLA experience with management of IPN. A retrospective review of patients with IPN treated at UCLA between 2002 and 2011 was conducted. Mean patient age was 53.4 years. Mean Ranson's score was 3.3 ± 2.3 and average number of concurrent comorbidities 3.2 ± 2.5. All patients were treated with intravenous antibiotics. Thirteen of 18 patients (72.2%) had percutaneous drainage catheters placed (mean 1.1 drains per patient). Two patients were treated with percutaneous drainage alone. Sixteen of 18 (88.9%) eventually underwent surgical débridement. Of the operative patients, mean time from diagnosis to surgery was 28.4 days. The mortality in this group was 16.7 per cent. In conclusion, antibiotics and percutaneous drainage is an acceptable and possibly preferable initial therapeutic strategy for patients with IPN. Delayed operation and early intervention with percutaneous drainage appears to improve mortality for these patients.

scholarly journals Direct endoscopic necrosectomy in infected pancreatic necrosis using lumen-apposing metal stents: Early intervention does not compromise outcome

2021 ◽  
Vol 09 (03) ◽  
pp. E490-E495
Author(s):  
David Albers ◽  
Alexander Meining ◽  
Alexander Hann ◽  
Younan Kabara Ayoub ◽  
Brigitte Schumacher
Keyword(s):  
Early Intervention ◽  
Pancreatic Necrosis ◽  
Early Stage ◽  
Clinical Success ◽  
Infected Pancreatic Necrosis ◽  
Metal Stents ◽  
Optimal Timing ◽  
Stent Insertion ◽  
Endoscopic Necrosectomy ◽  
Walled Off Necrosis

Abstract Background and study aims Infection of pancreatic necrosis is a dreaded complication requiring an intervention. Nevertheless, the optimal timing of the first intervention is unclear, and consensus data are sparse. This retrospective two-center study evaluated direct endoscopic necrosectomy using lumen apposing metal stents in case of proven or suspected infected pancreatic necrosis in an early stage of the disease. Patients and methods Forty-nine patients with infected pancreatic necrosis were included. Sequent direct endoscopic necrosectomies after lumen apposing metal stent insertion (LAMS) were performed until the resolution of necrosis. In all patients, the first endoscopic intervention was performed within the first 30 days after first proof of pancreatic necrosis. Primary outcome parameters were inflammatory activity, days spent in the Intensive Care Unit (ICU), and mortality. Results The patient cohort received median 4 necrosectomies (3–5) after a median of 7 days (3–11) after first proof of pancreatic necrosis. Technical and clinical success were achieved in 98.3 % and 87.8 %, respectively; the mortality rate was 8.2 %. The median C-reactive protein level decreased from 241 mg/L (182.9–288.9) before the intervention to a median of 23.3 mg/L (18–60) after therapy. The median time period in the ICU was 5 days (3–9). Conclusions Early endoscopic therapy in the form of direct endoscopic necrosectomy after LAMS placement within the first 30 days after proof of pancreatic necrosis is effective and does not result in poor outcome. Our retrospective data suggest that early intervention before walled-off necrosis is formed is tenable when it is essential due to the patient's clinical deterioration.

Current Surgical Management of Infected Pancreatic Necrosis

2010 ◽  
Vol 76 (10) ◽  
pp. 1096-1099 ◽  
Author(s):  
Brendan Boland ◽  
Steven Colquhoun ◽  
Vijay Menon ◽  
Amanda Kim ◽  
Simon Lo ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Challenging Problem ◽  
Surgical Service ◽  
Single Procedure ◽  
Pancreatic Debridement ◽  
Single Intervention ◽  
The Mean ◽  
Mean Time

Infected pancreatic necrosis (IPN) continues to be a challenging problem for the surgeon. We reviewed the experience on a hepatobiliary surgical service with patients who required operative intervention for IPN with emphasis on surgical approach, timing of surgery, and complications. Between 2002 and 2008, 21 patients underwent surgery for IPN. The initial surgical approach in these 21 patients included either direct pancreatic debridement (DPD, n = 13) or transgastric debridement using cyst-gastrostomy (CG, n = 8). Fifteen patients (71%) required only a single procedure, whereas three (14%) required two procedures and three (14%) required three procedures. The mean time from onset of pancreatitis to operation was 77 days. Patients requiring a single intervention had a longer interval from onset of pancreatitis to surgery compared with those requiring multiple interventions. When comparing CG and DPD groups, there was a longer interval from onset of pancreatitis to debridement, a lower chance of needing multiple debridements, and fewer pancreatic fistulae in the CG group. Overall survival was 95 per cent. Our results demonstrate that CG can be successfully used in select patients with IPN. Patients undergoing CG are less likely to require repeat surgical debridement and to develop pancreatic fistulae compared with patients undergoing DPD.

scholarly journals Ultrasound-guided percutaneous drainage of infected pancreatic necrosis

2013 ◽  
Vol 27 (11) ◽  
pp. 4397-4398 ◽  
Author(s):  
Marek Wroński ◽  
Włodzimierz Cebulski ◽  
Dominika Karkocha ◽  
Maciej Słodkowski ◽  
Łukasz Wysocki ◽  
...  
Keyword(s):  
Percutaneous Drainage ◽  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Ultrasound Guided

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 Ultrasound-guided percutaneous drainage of infected pancreatic necrosis

2013 ◽  
Vol 27 (8) ◽  
pp. 2841-2848 ◽  
Author(s):  
Marek Wroński ◽  
Włodzimierz Cebulski ◽  
Dominika Karkocha ◽  
Maciej Słodkowski ◽  
Łukasz Wysocki ◽  
...  
Keyword(s):  
Percutaneous Drainage ◽  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Ultrasound Guided

scholarly journals The two-port laparoscopic retroperitoneal approach for minimal access pancreatic necrosectomy

2015 ◽  
Vol 97 (5) ◽  
pp. 354-358 ◽  
Author(s):  
AB Cresswell ◽  
H Nageswaran ◽  
A Belgaumkar ◽  
R Kumar ◽  
N Menezes ◽  
...  
Keyword(s):  
Critical Care ◽  
Percutaneous Drainage ◽  
Pancreatic Necrosis ◽  
Median Number ◽  
Infected Pancreatic Necrosis ◽  
High Rate ◽  
Morbidity Rate ◽  
Minimal Access ◽  
Severe Pancreatitis ◽  
Open Necrosectomy

Introduction Despite advances in surgery and critical care, severe pancreatitis continues to be associated with a high rate of mortality, which is increased significantly in the presence of infected pancreatic necrosis. Controversy persists around the optimal treatment for such cases, with specialist units variously advocating open necrosectomy, simple percutaneous drainage or one of several minimal access approaches. We describe our technique and outcomes with a two-port laparoscopic retroperitoneal necrosectomy (2P-LRN). Methods Thirteen consecutive patients with proven infected pancreatic necrosis were treated by 2P-LRN over a three-year period in the setting of a specialist hepatopancreatobiliary unit. The median patient age was 46 years (range: 28–87 years) and 10 of the patients were male. Results The median number of procedures required to clear the necrosis was 2 (range: 1–5), with a median time to discharge following the procedure of 44 days (range: 10–135 days). There was no 90-day mortality and the morbidity rate was 38%, consisting of pancreatic fistula (31%) and bleeding (23%). Conclusions Two-port laparoscopic retroperitoneal necrosectomy has been demonstrated to confer similar or better outcomes to other techniques for necrosectomy. It carries the additional advantages of better visualisation, leading to fewer procedures and the opportunity to deploy simple laparoscopic instruments such as diathermy or haemostatic clips.

Serum calprotectin in infected pancreatic necrosis

2013 ◽  
Vol 51 (05) ◽  
Author(s):  
V Terzin ◽  
I Földesi ◽  
R Róka ◽  
Z Szepes ◽  
T Wittmann ◽  
...  
Keyword(s):  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis
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