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.

Minimally invasive techniques in the treatment of severe acute pancreatitis

Open Medicine ◽  
2014 ◽  
Vol 9 (4) ◽  
pp. 580-587 ◽  
Author(s):  
Ignasi Poves ◽  
Fernando Burdío ◽  
Dimitri Dorcaratto ◽  
Luis Grande
Keyword(s):  
Acute Pancreatitis ◽  
Surgical Treatment ◽  
Minimally Invasive ◽  
Severe Acute Pancreatitis ◽  
Pancreatic Necrosis ◽  
High Rate ◽  
Multidisciplinary Teams ◽  
Laparoscopic Transperitoneal ◽  
Open Necrosectomy ◽  
Invasive Techniques

AbstractOpen necrosectomy, the standard surgical treatment of infected pancreatic necrosis (IPN), presents a high rate of postoperative complications and an associated mortality of 20–60%. In the last decade various minimally invasive approaches (MIA) have been proposed for the treatment of IPN and the results seem to improve on those reported with open necrosectomy. These MIA include: percutaneous, retroperitoneal, endoscopic (endoluminal) and laparoscopic (transperitoneal). The adoption of the step-up approach in the management of severe acute pancreatitis (SAP) facilitates the implementation of MIA as the surgical treatment of choice in most cases. Since MIA require the expertise of radiologists, endoscopists and surgeons, patients suffering SAP should be treated by multidisciplinary teams in referral centers. We describe the MIA currently available and discuss their advantages, disadvantages, and results.

scholarly journals HSV encephalitis after successful minimally invasive debridement for infected pancreatic necrosis: A case of rare central nervous system complication

2021 ◽  
Vol 19 ◽  
pp. 205873922110005
Author(s):  
Bei Lu ◽  
Yang Cai ◽  
Junjie Yin ◽  
Jingrui Wang ◽  
Zhong Jia ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Acute Pancreatitis ◽  
Nervous System ◽  
Herpes Simplex ◽  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Percutaneous Catheter Drainage ◽  
Central Nervous System Complication ◽  
Simplex Virus

Patients with acute pancreatitis (AP) often suffer tough complications, some of which are fatal. The early diagnosis and definite treatment of central nervous system (CNS) complications have not been fully achieved yet, which seriously affects the mortality of severe acute pancreatitis (SAP). We present a case of infected pancreatic necrosis (IPN) in a 62-year Chinese man who developed acute herpes simplex encephalitis (HSE) caused by herpes simplex virus type 1 (HSV-1) after favorable minimally invasive retroperitoneal approaches (MIRAs). The patient was successfully treated with 115 days stayed in our hospital. The MIRAs included image-guided retroperitoneal percutaneous catheter drainage (PCD), nephroscopic pancreatic necrosectomy (NPN), and ultrasonic pneumatic lithotripsy system (UPLS) assisted non-narcotic sinus track necrosectomy (NSN). HSE is relatively rare and potentially life threatening. We attempt to discuss the probable risk factors and how the relatively rare HSE are related to the patients of SAP with latent HSV.

OPTIMIZATION OF SURGICAL TREATMENT OF PATIENTS WITH ACUTE PANCREATITIS USING MINIINVASIVE TECHNIQUES

2020 ◽  
pp. 16-18
Author(s):  
A. G. Drozdova
Keyword(s):  
Acute Pancreatitis ◽  
Surgical Treatment ◽  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Minimal Invasive ◽  
Hospital Treatment ◽  
Bed Days ◽  
Minimal Invasive Techniques ◽  
Invasive Techniques

Summary. The aim of the study. To improve the results of surgical treatment of patients with acute pancreatitis using minimal invasive techniques. Matherials and Methods of the study. The results of surgical treatment of 75 patients with different forms of acute pancreatitis were analyzed. All patients were examined and operated on. Results of the study. Minimally invasive interventions were performed in 92 % of the analyzed patients. Intraoperatively acute pancreatic edema was observed in 43 % of patients, hemorrhagic pancreatic necrosis – in 24 %, infected pancreatic necrosis – in 33 %. The postoperative period was complicated by 13.3 %, the mortality rate was 9.3 %. Conclusions. The use of minimally invasive techniques for treating acute pancreatitis can significantly improve the results of surgical treatment of patients with this pathology. The frequency of complications and lethality decreases. Also, it is possible to significantly reduce operational trauma, and hence the number of bed-days of stay in hospital treatment. This contributes to reducing the financial cost of treatment in patients with acute pancreatitis, as well as improving the quality of life of this category of patients.

scholarly journals Management of Splenic Abscess after Splenic Arterial Embolization in Severe Acute Pancreatitis: A 5-Year Single-Center Experience

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Gang Li ◽  
Lin Gao ◽  
Jing Zhou ◽  
Bo Ye ◽  
Jingzhu Zhang ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Minimally Invasive ◽  
Severe Acute Pancreatitis ◽  
Splenic Artery ◽  
Pancreatic Necrosis ◽  
Splenic Abscess ◽  
Arterial Embolization ◽  
Massive Bleeding ◽  
Massive Hemorrhage ◽  
Single Center Experience

Objective. To describe the management and prognosis of splenic abscess after splenic arterial embolization in severe acute pancreatitis (SAP) patients.Methods. This is a retrospective observational study. From August 2012 to August 2017, SAP patients with infected pancreatic necrosis (IPN) who underwent splenic arterial embolization after massive hemorrhage of the splenic artery were screened and those who developed splenic abscess were included for analysis. The demographic characteristics, etiology, treatment of splenic abscess, and clinical outcomes of these cases were collected and analyzed.Results. A total of 18 patients with splenic abscess formed after splenic arterial embolization were included for data analysis. The median age of the 18 patients was 46 years. The etiologies included biliary AP, hypertriglyceridemic AP (HTG-AP), and other causes. Ten patients underwent minimally invasive percutaneous drainage only for splenic abscess while the other eight patients received splenectomy. One patient died due to uncontrolled infection and another patient died due to massive bleeding, and the remaining sixteen patients survived.Conclusion. The incidence of splenic abscess was high in patients requiring splenic arterial embolization due to massive bleeding. Our data showed that most splenic abscess could be successfully managed with minimally invasive interventions, and traditional splenectomy should serve as a backup treatment.

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.

scholarly journals Acute necrotising pancreatitis - causes of deaths: single-centre retrospective study

2019 ◽  
Vol 12 (1) ◽  
pp. 29-37
Author(s):  
Denis Vladimirovich Mizgirev ◽  
Valeriy Vladimirovich Kremlev ◽  
Lyudmila Aleksandrovna Neledova ◽  
Victor Nikolaevich Pozdeev ◽  
Anastasiya Andriyanovna Katysheva ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Abdominal Cavity ◽  
Infectious Complications ◽  
Endotoxin Shock ◽  
Invasive Treatment ◽  
Surgical Interventions ◽  
Late Mortality ◽  
Causes Of Deaths

Relevance. There is a discussion about the prevalence of early or late mortality and the main causes of death in different phases of acute pancreatitis. Analysis of mortality is important for the determination of ways to improve the results of treatment of pancreatic necrosis. Aim of the research is analysis of the structure, timing characteristics and causes of deaths in pancreatic necrosis, the effect of the configuration of parapancreatitis and surgical tactics on the outcome of the disease. Materials and methods. Retrospective single-center study of lethal outcomes in acute pancreatitis was performed, the structure of mortality, cases of discrepancies in diagnoses, the timing of the onset and causes of deaths of patients were studied. The lethal outcomes were compared in the operated patients, the frequency of the mesentery root involvement, the indications and the timing of the interventions were assessed. Results. The ratio of early and late mortality was 45,2% to 54,8%, respectively. The main causes of early mortality – endotoxin shock and multi-organ failure, late one – infectious complications. In 9,6% of the patients, the diagnosis was made only with an autopsy. The prognostic value of the SOFA and SAPS II scales is characterized as low. The tactics of surgical treatment has changed in favour of minimally invasive surgery. The average conversion time for ineffective percutaneous procedures was 21,4 days. The involvement of mesentery in parapancreatitis was often accompanied by a breakthrough of the abscess into the abdominal cavity. Conclusion. The surgical component of the reduction in mortality is the rejection of unreasonable surgical interventions, the earlier conversion to "traditional" operations in case of ineffective minimally invasive treatment and the allocation of "central" localization of parapancreatitis as a serious prognostic factor of the course of severe pancreatitis.

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.

scholarly journals OPTIMIZATION OF SURGICAL TREATMENT OF PATIENTS WITH ACUTE PANCREATITIS USING MINIINVASIVE TECHNIQUES

2019 ◽  
pp. 63-65
Author(s):  
A. G. Drozdova
Keyword(s):  
Acute Pancreatitis ◽  
Surgical Treatment ◽  
Minimally Invasive ◽  
Pancreatic Necrosis ◽  
Minimal Invasive ◽  
Hospital Treatment ◽  
Bed Days ◽  
Minimal Invasive Techniques ◽  
Invasive Techniques

Abstract. The aim of the study. To improve the results of surgical treatment of patients with acute pancreatitis using minimal invasive techniques. Matherials and Methods of the study. The results of surgical treatment of 75 patients with different forms of acute pancreatitis were analyzed. All patients were examined and operated on. Results of the study. Minimally invasive interventions were performed in 92% of the analyzed patients. Intraoperatively acute pancreatic edema was observed in 43% of patients, hemorrhagic pancreatic necrosis – in 24%, infected pancreatic necrosis – in 33%. The postoperative period was complicated by 13.3%, the mortality rate was 9.3%. Conclusions. The use of minimally invasive techniques for treating acute pancreatitis can significantly improve the results of surgical treatment of patients with this pathology. The frequency of complications and lethality decreases. Also, it is possible to significantly reduce operational trauma, and hence the number of bed-days of stay in hospital treatment. This contributes to reducing the financial cost of treatment in patients with acute pancreatitis, as well as improving the quality of life of this category of patients.

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