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.

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.

Treatment for Infected Pancreatic Necrosis Should be Delayed, Possibly Avoiding an Open Surgical Approach

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Claudio Ricci ◽  
Nico Pagano ◽  
Carlo Ingaldi ◽  
Leonardo Frazzoni ◽  
Marina Migliori ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Open Surgical Approach

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.

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.

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 Surgical Approaches in Odontogenic Orbital Cellulitis (OOC): Our Experience and Review of Literature

2021 ◽  
Author(s):  
Romano Antonio ◽  
Troise Stefania ◽  
Committeri Umberto ◽  
Arena Antonio ◽  
Giovanni Dell’Aversana Orabona ◽  
...  
Keyword(s):  
Surgical Approach ◽  
Early Stage ◽  
Orbital Cellulitis ◽  
Surgical Approaches ◽  
Endoscopic Drainage ◽  
Review Of Literature ◽  
Dental Infection ◽  
Transnasal Approach ◽  
Different Types ◽  
Stage Infection

AbstractAims Odontogenic orbital cellulitis represents a complication of root infections of upper pre-molars and molars. The severity depends on the orbital structure involved. The treatment is based on antibiotic therapy associated or not to surgery. Through the presentation of three cases and a review of literature, we purpose as aim of our study to underline the necessity of a timely diagnosis and to provide the correct surgical approach in each different types and stages of orbital infections. Methods We present three patients that were affected by dental infection evolved in orbital cellulitis. In two cases the disease was solved with the extraction of infected tooth and a surgical endoscopic drainage of the abscess through antrostomy of maxillary sinus. In the third patient the disease had already induced a bulbar perforation and endophthalmitis, so an orbit evisceration was necessary. Results Review of literature showed that the standard treatment of orbital cellulitis is the transnasal approach associated or not by a transoral and/or transcutaneous procedure depending on the stage of the disease and on the causes. In our 3 cases these indications were followed without relapses of the disease. Conclusion An early diagnosis is mandatory in odontogenic orbital cellulitis specially to avoid serious complications. Surgical treatment can be simple and effective mostly in early-stage infection: it is based on extraction of infected tooth and on the drainage of abscess. Surgical approach consists in transnasal procedure flanked or not by transoral and transcutaneous procedures based on the stage of the infection considering involved structures.

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

scholarly journals Infected Pancreatic Necrosis Mimicking Pancreatic Cancer

2020 ◽  
Vol 14 (2) ◽  
pp. 436-442
Author(s):  
Jun Heo
Keyword(s):  
Pancreatic Cancer ◽  
Abdominal Pain ◽  
Endoscopic Ultrasound ◽  
Fine Needle Aspiration ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Needle Aspiration ◽  
Infected Pancreatic Necrosis ◽  
Ultrasound Guided ◽  
Fine Needle

Although infected pancreatic necrosis can develop as a result of rare conditions involving trauma, surgery, and systemic infection with an uncommon pathogen, it usually occurs as a complication of pancreatitis. Early phase of acute pancreatitis can be either edematous interstitial pancreatitis or necrotizing pancreatitis. The late complications of pancreatitis can be divided into pancreatic pseudocyst due to edematous interstitial pancreatitis or walled-off necrosis due to necrotizing pancreatitis. During any time course of pancreatitis, bacteremia can provoke infection inside or outside the pancreas. The patients with infected pancreatic necrosis may have fever, chills, and abdominal pain as inflammatory symptoms. These specific clinical presentations can differentiate infected pancreatic necrosis from other pancreatic diseases. Herein, I report an atypical case of infected pancreatic necrosis in which abdominal pain, elevation of white blood cell, and fever were not found at the time of admission. Rather, a 10-kg weight loss (from 81 to 71 kg) over 2 months nearly led to a misdiagnosis of pancreatic cancer. The patient was finally diagnosed based on endoscopic ultrasound-guided fine-needle aspiration. This case highlights that awareness of the natural course of pancreatitis and infected pancreatic necrosis is important. In addition, endoscopic ultrasound-guided fine-needle aspiration should be recommended for the diagnosis and treatment of indeterminate pancreatic lesions in selected patients.

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