scholarly journals Minimally invasive drainage versus open surgical debridement in SAP/SMAP – a network meta-analysis

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kai Zhang ◽  
Xiaole Zhu ◽  
Chaoqun Hou ◽  
Chenyuan Shi ◽  
Yi Miao ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Minimally Invasive ◽  
Severe Acute Pancreatitis ◽  
Meta Analysis ◽  
Multiple Organ ◽  
Surgical Debridement ◽  
Percutaneous Catheter Drainage ◽  
Endoscopic Drainage ◽  
Percutaneous Catheter ◽  
Study Participants

Abstract Background The efficacy of some therapeutic methods (open surgical debridement (OSD), conservative treatment (CST) and minimally invasive drainage (MID)) for severe acute pancreatitis (SAP) and moderately severe acute pancreatitis (MSAP) has been widely evaluated. However, the results remained controversial. We performed this study to illuminate whether any difference in incidence exists on patients with SAP/MSAP treated with OSD and MID. Methods Eligible articles were collected base of a comprehensive review of PUBMED, EMBASE, COCHRANE, CKNI and WANGFANG for published randomized controlled trials. Two steps of meta-analysis were performed, routine pair-wise meta-analysis and network meta-analysis. Results Thirteen studies were included in this study. Participants were classed as 5 groups, CST, early MID (EMID), late MID (LMID), early OSD (EOSD) and late OSD (LOSD). And MID contains endoscopic drainage (ESD), percutaneous catheter drainage (PCD) and minimally invasive surgery (MIS). Compared with CST, MID could decrease both mortality and multiple organ dysfunction syndrome (MODS) rate but OSD couldn’t. Both EMID and MID can significantly decrease the mortality and MODS rate compared to CST. PCD might be most likely to have a benefit compared to CST. Conclusion Existing evidence for the use of MID in SAP/MSAP is reliable and it can be used as early treatment. OSD, if necessary, should be avoided or delayed as long as possible.

scholarly journals Combined Surgical Tactics with Step-up Approach in the Treatment of Infected Acute Pancreatitis

2020 ◽  
Vol 87 (3-4) ◽  
pp. 3-9
Author(s):  
I. A. Kryvoruchko ◽  
V. V. Boyko ◽  
K. Yu. Parkhomenko ◽  
A. G. Drozdova ◽  
S. A. Andreieshchev
Keyword(s):  
Acute Pancreatitis ◽  
Postoperative Complications ◽  
Minimally Invasive ◽  
Open Surgery ◽  
Postoperative Mortality ◽  
Multiple Organ ◽  
Percutaneous Catheter Drainage ◽  
Results Of Treatment ◽  
Surgical Tactics ◽  
Open Necrosectomy

Objective. To evaluate the results of treatment using minimally invasive interventions and open necrectomy in patients with infected acute pancreatitis. Materials and methods. A retrospective cohort two-centered analysis was performed in 211 patients with infected acute pancreatitis who divided into two groups: the first included 101 patients, in the treatment of which used open surgery; the second included 110 patients, in the treatment of which used treatment tactic step-up approach. Results. In the first group used open necrosectomy with drainage for postoperative lavage (75 patients, 74.3%), including open packing with planned re-laparotomy (8 patients, 7.9%), and omentobursostomy for necrosectomy after surgery (18 patients, 17.8%). Postoperative complications occurred in 58 (57.4%), after the surgery 34 (33.7%) patients was died: 30 had a thirty-day mortality, and 4 had a ninety-day mortality. In the second group group, 72 (65.5%) patients were treated by percutaneous catheter drainage, 6 (5.5%) by video-assisted retroperitoneal debridement and drainage, 5 (4.5%) by through the wall of the stomach or duodenum in the infected pseudocyst and open necrosectomy was performed on 27 (24.5%) patients. Postoperative complications occurred in 37 (33.6%) patients, after the surgery 19 (17.3%) was died: 15 had a thirty -day mortality and 4 had a ninety-day mortality. In the regression analysis, only the presence of multiple organ dysfunction before (AUC = 0.867) and after surgery (AUC = 0.930) significantly affected postoperative mortality, but the effect of the prevalence of pancreatic necrosis (AUC = 0.693) on mortality was limited. Differences were likely between groups (χ2=7.282, p=0.026). Conclusion. The surgical treatment should be initiated with a minimally invasive procedures and combination these operations with open surgery was able to reduce complications and mortality in the patients with infected acute pancreatitis.

Sign in / Sign up

Export Citation Format

Share Document