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 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.

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.

Impact of characteristics of organ failure and infected necrosis on mortality in necrotising pancreatitis

Gut ◽  
2018 ◽  
Vol 68 (6) ◽  
pp. 1044-1051 ◽  
Author(s):  
Nicolien J Schepers ◽  
Olaf J Bakker ◽  
Marc G Besselink ◽  
Usama Ahmed Ali ◽  
Thomas L Bollen ◽  
...  
Keyword(s):  
Organ Failure ◽  
Pancreatic Necrosis ◽  
Multiple Organ ◽  
Infected Pancreatic Necrosis ◽  
Disease Course ◽  
Infected Necrosis ◽  
Persistent Organ Failure ◽  
Necrotising Pancreatitis ◽  
Post Hoc ◽  
Prospective Database

ObjectiveIn patients with pancreatitis, early persisting organ failure is believed to be the most important cause of mortality. This study investigates the relation between the timing (onset and duration) of organ failure and mortality and its association with infected pancreatic necrosis in patients with necrotising pancreatitis.DesignWe performed a post hoc analysis of a prospective database of 639 patients with necrotising pancreatitis from 21 hospitals. We evaluated the onset, duration and type of organ failure (ie, respiratory, cardiovascular and renal failure) and its association with mortality and infected pancreatic necrosis.ResultsIn total, 240 of 639 (38%) patients with necrotising pancreatitis developed organ failure. Persistent organ failure (ie, any type or combination) started in the first week in 51% of patients with 42% mortality, in 13% during the second week with 46% mortality and in 36% after the second week with 29% mortality. Mortality in patients with persistent multiple organ failure lasting <1 week, 1–2 weeks, 2–3 weeks or longer than 3 weeks was 43%, 38%, 46% and 52%, respectively (p=0.68). Mortality was higher in patients with organ failure alone than in patients with organ failure and infected pancreatic necrosis (44% vs 29%, p=0.04). However, when excluding patients with very early mortality (within 10 days of admission), patients with organ failure with or without infected pancreatic necrosis had similar mortality rates (28% vs 34%, p=0.33).ConclusionIn patients with necrotising pancreatitis, early persistent organ failure is not associated with increased mortality when compared with persistent organ failure which develops further on during the disease course. Furthermore, no association was found between the duration of organ failure and mortality.

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 Current management of infected pancreatic necrosis in a referral center. should open necrosectomy be abandoned?

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S766
Author(s):  
J.F. Roldan De La Rua ◽  
S. Mansilla Diaz ◽  
L.C. Hinojosa Arco ◽  
A. Ortega Martinez ◽  
Y. Eslava Cea ◽  
...  
Keyword(s):  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Current Management ◽  
Referral Center ◽  
Open Necrosectomy

Transmural endoscopic drainage and local infusion of antibiotics through nasocystic catheter in infected pancreatic necrosis: Is possible to avoid necrosectomy?

Pancreatology ◽  
2017 ◽  
Vol 17 (5) ◽  
pp. S4-S5
Author(s):  
J. Lariño Noia ◽  
J. González López ◽  
D. de la Iglesia García ◽  
J. Iglesias García ◽  
R. Mejuto Fernández ◽  
...  
Keyword(s):  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Endoscopic Drainage

Evaluation of a protocol of transmural endoscopic drainage of infected pancreatic necrosis (IPN) with local antibiotherapy through nasocystic catheter

Pancreatology ◽  
2017 ◽  
Vol 17 (3) ◽  
pp. S76
Author(s):  
Jose Lariño-Noia ◽  
Javier López-Díaz ◽  
Daniel De la Iglesia-García ◽  
Julio Iglesias-García ◽  
Rafael Mejuto-Fernández ◽  
...  
Keyword(s):  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Endoscopic Drainage

scholarly journals The Use of Prophylaxis Antibiotics to Prevent Acute Pancreatitis Complications: Meta-Analysis of Clinical Trials

2022 ◽  
Vol 22 (3) ◽  
pp. 196-202
Author(s):  
Dwita Nitoya Esterini ◽  
Kirsten Putriani Hartman ◽  
Joue Abraham Trixie ◽  
Yessi Setianegari ◽  
Kurniyanto Kurniyanto
Keyword(s):  
Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
Data Extraction ◽  
Meta Analysis ◽  
Infected Pancreatic Necrosis ◽  
Definitive Treatment ◽  
Medical Database ◽  
Infected Necrosis ◽  
Risk Of Mortality ◽  
Significant Difference

Background: Acute pancreatitis (AP) is an inflammation of the pancreas, a serious emergency with no definitive treatment. It may progress to infected necrosis, non-pancreatitis infection, also death that may occur within the first 1 to 2 weeks. The use of prophylactic antibiotics in AP to prevent complications remains a controversy. The objective of this meta-analysis is to assess the benefit of prophylaxis antibiotics administration to prevent the complication.Method: Trials were identified by searching the medical database. Literature range is within the year 1975 to 2021.  Review Manager 5.4.1 was used to analyse data extraction and risk of bias of included studies were elaborated. Risk ratio (RR) was calculated with 95% confidence interval (CI). P 0.05 was considered significant.Results: Twenty trials with a total of 1.287 patients of AP were analysed; 646 patients treated with antibiotic prophylaxis and 641 patients treated with placebo. Prophylaxis antibiotics were found to have significant difference between the two groups. The administration of prophylaxis antibiotics lower the risk of non-pancreatic infections (RR = 0.77; 95% CI: 0.62–0.95; p 0.05) and infected pancreatic necrosis (RR = 0.74; 95% CI: 0.58-0.94; p 0.05). Meanwhile, prophylaxis antibiotics were found to be insignificant to lower the risk of mortality (RR = 0.75; 95% CI: 0.54-1.03; p 0.05). Conclusion: Prophylaxis antibiotics lower the risk of non-pancreatic infections and infected pancreatic necrosis, but did not lower the risk of mortality.

scholarly journals Endoscopic transmural drainage and necrosectomy in acute necrotizing pancreatitis: A review

2021 ◽  
Vol 9 (3) ◽  
pp. 168-176
Author(s):  
Linlin Feng ◽  
Jintao Guo ◽  
Sheng Wang ◽  
Xiang Liu ◽  
Nan Ge ◽  
...  
Keyword(s):  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Acute Necrotizing Pancreatitis ◽  
Current Status ◽  
Endoscopic Drainage ◽  
Mortality And Morbidity ◽  
Endoscopic Techniques ◽  
Acute Necrotizing ◽  
Open Necrosectomy ◽  
Invasive Techniques

Abstract Acute necrotizing pancreatitis occurs in 10%–20% of patients with acute pancreatitis (AP) which is one of the most important acute abdominal diseases that require hospital admission. Pancreatic necrosis is also associated with high mortality and morbidity. In the past 20 years, the treatment of pancreatic necrosis has shifted from open necrosectomy to minimally invasive techniques, such as endoscopic interventions. With the development of endoscopic techniques, the safety and effectiveness of endoscopic interventions have improved, but there exist several unresolved problems. Currently, there is no unified standard approach for endoscopic treatment of pancreatic necrosis that takes into account local expertise, anatomical features of necrosis, patients’ preferences, and comorbidity profile. We reviewed the current status of endoscopic therapy for acute necrotizing pancreatitis, focusing on the new endoscopic drainage technique and necrosectomy protocol.

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