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.

Quality of training in cervical cancer radical surgery: a survey from the European Network of Young Gynaecologic Oncologists (ENYGO)

2022 ◽  
pp. ijgc-2021-002812
Author(s):  
Nicolò Bizzarri ◽  
Andrei Pletnev ◽  
Zoia Razumova ◽  
Kamil Zalewski ◽  
Charalampos Theofanakis ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Minimally Invasive ◽  
Radical Surgery ◽  
Gynecologic Oncology ◽  
Laparoscopic Approach ◽  
High Volume ◽  
Lymph Node Biopsy ◽  
European Network ◽  
Before And After ◽  
Level Of Training

BackgroundThe European Society of Gynaecological Oncology (ESGO) and partners are committed to improving the training for gynecologic oncology fellows. The aim of this survey was to assess the type and level of training in cervical cancer surgery and to investigate whether the Laparoscopic Approach to Cervical Cancer (LACC) trial results impacted training in radical surgery for gynecologic oncology fellows.MethodsIn June 2020, a 47-question electronic survey was shared with European Network of Young Gynaecologic Oncologists (ENYGO) members. Specialist fellows in obstetrics and gynecology, and gynecologic oncology, from high- and low-volume centers, who started training between January 1, 2017 and January 1, 2020 or started before January 1, 2017 but finished their training at least 6 months after the LACC trial publication (October 2018), were included.Results81 of 125 (64.8%) respondents were included. The median time from the start of the fellowship to completion of the survey was 28 months (range 6–48). 56 (69.1%) respondents were still fellows-in-training. 6 of 56 (10.7%) and 14 of 25 (56.0%) respondents who were still in training and completed the fellowship, respectively, performed ≥10 radical hysterectomies during their training. Fellows trained in an ESGO accredited center had a higher chance to perform sentinel lymph node biopsy (60.4% vs 30.3%; p=0.027). There was no difference in the mean number of radical hysterectomies performed by fellows during fellowship before and after the LACC trial publication (8±12.0 vs 7±8.4, respectively; p=0.46). A significant reduction in number of minimally invasive radical hysterectomies was noted when comparing the period before and after the LACC trial (38.5% vs 13.8%, respectively; p<0.001).ConclusionExposure to radical surgery for cervical cancer among gynecologic oncology fellows is low. Centralization of cervical cancer cases to high-volume centers may provide an increase in fellows’ exposure to radical procedures. The LACC trial publication was associated with a decrease in minimally invasive radical hysterectomies performed by fellows.

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.

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 %.

scholarly journals Minimally invasive esophagectomy for cancer: Single center experience after 44 consecutive cases

2015 ◽  
Vol 143 (7-8) ◽  
pp. 410-415 ◽  
Author(s):  
Milos Bjelovic ◽  
Tamara Babic ◽  
Dragan Gunjic ◽  
Milan Veselinovic ◽  
Bratislav Spica
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Laparoscopic Approach ◽  
Standard Of Care ◽  
High Volume ◽  
Thoracic Esophagus ◽  
Digestive Surgery ◽  
Invasive Esophagectomy ◽  
Open Esophagectomy

Introduction. At the Department of Minimally Invasive Upper Digestive Surgery of the Hospital for Digestive Surgery in Belgrade, hybrid minimally invasive esophagectomy (hMIE) has been a standard of care for patients with resectable esophageal cancer since 2009. As a next and final step in the change management, from January 2015 we utilized total minimally invasive esophagectomy (tMIE) as a standard of care. Objective. The aim of the study was to report initial experiences in hMIE (laparoscopic approach) for cancer and analyze surgical technique, major morbidity and 30-day mortality. Methods. A retrospective cohort study included 44 patients who underwent elective hMIE for esophageal cancer at the Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia in Belgrade from April 2009 to December 2014. Results. There were 16 (36%) middle thoracic esophagus tumors and 28 (64%) tumors of distal thoracic esophagus. Mean duration of the operation was 319 minutes (approximately five hours and 20 minutes). The average blood loss was 173.6 ml. A total of 12 (27%) of patients had postoperative complications and mean intensive care unit stay was 2.8 days. Mean hospital stay after surgery was 16 days. The average number of harvested lymph nodes during surgery was 31.9. The overall 30-day mortality rate within 30 days after surgery was 2%. Conclusion. As long as MIE is an oncological equivalent to open esophagectomy (OE), better relation between cost savings and potentially increased effectiveness will make MIE the preferred approach in high-volume esophageal centers that are experienced in minimally invasive procedures.

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

scholarly journals Various Endoscopic Techniques for Treatment of Consequences of Acute Necrotizing Pancreatitis: Practical Updates for the Endoscopist

2020 ◽  
Vol 9 (1) ◽  
pp. 117
Author(s):  
Mateusz Jagielski ◽  
Marian Smoczyński ◽  
Jacek Szeliga ◽  
Krystian Adrych ◽  
Marek Jackowski
Keyword(s):  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Acute Necrotizing Pancreatitis ◽  
Minimally Invasive Treatment ◽  
Interventional Treatment ◽  
Endoscopic Drainage ◽  
Invasive Treatment ◽  
Endoscopic Techniques ◽  
Acute Necrotizing

Despite great progress in acute pancreatitis (AP) treatment over the last 30 years, treatment of the consequences of acute necrotizing pancreatitis (ANP) remains controversial. While numerous reports on minimally invasive treatment of the consequences of ANP have been published, several aspects of interventional treatment, particularly endoscopy, are still unclear. In this article, we attempt to discuss these aspects and summarize the current knowledge on endoscopic therapy for pancreatic necrosis. Endotherapy has been shown to be a safe and effective minimally invasive treatment modality in patients with consequences of ANP. The evolution of endoscopic techniques has made endoscopic drainage more effective and reduced the use of other minimally invasive therapies for pancreatic necrosis.

scholarly journals Minimally invasive surgery in the treatment of acute pancreatitis

2020 ◽  
Vol 11 (4) ◽  
pp. 75-80
Author(s):  
Eldar E. Topuzov ◽  
Bella G. Tsatinyan ◽  
Eskender G. Topuzov ◽  
Vyacheslav K. Balashov ◽  
Esma A. Arshba ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Medical Records ◽  
Pancreatic Necrosis ◽  
Surgical Intervention ◽  
Minimally Invasive Techniques ◽  
Severe Degree ◽  
Invasive Techniques ◽  
Positive Effect

Background. In recent years, the lethality from acute pancreatitis in Russia has not undergone significant changes and according to various data is from 15% to 25%. Purpose. The evaluation of the performing minimally invasive interventions in the treatment of patients with moderate to severe acute pancreatitis. Materials and methods. The authors retrospectively analyzed the medical records of 169 patients, the structure of mortality and complications depending on the choice of surgical intervention for the patients with acute pancreatitis of moderate and severe degree. Results. Lethal outcomes in the group of patients using minimally invasive interventions amounted to 11.5%, in the group of patients using traditional operations 37.5%, p 0.05. Laparoscopic interventions were effective in 88.8% of the cases, and drug therapy had a positive effect in 81.2% of the cases, p 0.05. Conclusion. It is shown that the use of minimally invasive techniques in the treatment of pancreatic necrosis significantly reduces the levels of mortality, postoperative complications, which improves the overall results of acute pancreatitis treatment.

scholarly journals Step-up Approach for Pancreatic Necrosis: A Case Report and Review of the Technique and Literature

2012 ◽  
Vol 1 (3) ◽  
pp. 206-209
Author(s):  
Rahul J Anand
Keyword(s):  
Case Report ◽  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
High Rate ◽  
Minimally Invasive Procedures ◽  
Invasive Procedures ◽  
The Common ◽  
Very High ◽  
Complicated Patient

ABSTRACT Necrotizing pancreatitis carries a very high rate of mortality and complications for these sick patients. Recent literature supports the delay in operative procedures as long as possible to decrease morbidity and mortality. Minimally invasive procedures can avoid laparotomy, but also introduce specific complications requiring immediate or secondary open operative treatment. Minimally invasive procedures require unique expertise and therefore should only be performed at specialized centers. This is a case report that describes a complicated patient with acute pancreatitis, necrotizing infection of a pseudocyst, intrusion of the pseudocyst to the common bile duct, among other complications. We describe the clinical and operative approach. How to cite this article Ferrada PA, Anand RJ. Step-up Approach for Pancreatic Necrosis: A Case Report and Review of the Technique and Literature. Panam J Trauma Critical Care Emerg Surg 2012;1(3):206-209.

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