scholarly journals Management of necrotizing pancreatitis and its outcome in a secondary healthcare institution

2017 ◽  
Vol 4 (3) ◽  
pp. 1049 ◽  
Author(s):  
Tanweer Karim ◽  
Vinod Kumar ◽  
Vivek Kumar Katiyar ◽  
Subhash K.
Keyword(s):  
Clinical Judgment ◽  
Pancreatic Necrosis ◽  
Necrotizing Pancreatitis ◽  
Operating Time ◽  
Surgical Techniques ◽  
Infected Pancreatic Necrosis ◽  
Minimal Access ◽  
Significant Difference ◽  
Surgical Conditions ◽  
Laparoscopic Techniques

Background: Surgical debridement is the “gold standard” for infected pancreatic necrosis. Advances in imaging methods and minimal access techniques have changed the management of many surgical conditions and even infected pancreatic necrosis has successfully been treated in selected patients. However, technical advances don’t obviate sound clinical judgment. Aim was to consider recent advances in minimal access surgery, this article retrospectively analyses the role of open surgery and laparoscopic techniques in the management of necrotizing pancreatitis.Methods: A retrospective study of 30 cases of pancreatic necrosectomy admitted and managed during 2012-2016 was carried out and compared with results available in the existing literature.Results: Out of 30 cases, 20 were men and 10 were women. Patients' age ranged from 23 to 70 years (mean age - 49.8 years). The mean operating time was 103.8 min (range, 60-120 min). Timing of necrosectomy was 21-32 days (average - 25.5 days). The average duration of hospital stay after the procedure was 17.4 days (range, 10-21 days).Conclusions: Comparative analysis of results of different surgical techniques reveals that there is no significant difference in terms of mortality. However, overall rate of complications and failure (inadequate debridement and drainage) are still higher with minimally invasive techniques.

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.

scholarly journals Total hip arthroplasty performed by direct anterior approach – Does experience influence the learning curve?

SICOT-J ◽  
2020 ◽  
Vol 6 ◽  
pp. 15 ◽  
Author(s):  
Constant Foissey ◽  
Mathieu Fauvernier ◽  
Cam Fary ◽  
Elvire Servien ◽  
Sébastien Lustig ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Learning Curve ◽  
Hip Arthroplasty ◽  
Anterior Approach ◽  
Operating Time ◽  
Surgical Techniques ◽  
Direct Anterior Approach ◽  
Clinical Results ◽  
Total Hip ◽  
Significant Difference

Introduction: Proficiency in the direct anterior approach (DAA) as with many surgical techniques is considered to be challenging. Added to this is the controversy of the benefits of DAA compared to other total hip arthroplasty (THA) approaches. Our study aims to assess the influence of experience on learning curve and clinical results when transitioning from THA via posterior approach in a lateral position to DAA in a supine position. Methods: A consecutive retrospective series of 525 total hip arthroplasty of one senior and six junior surgeons was retrospectively analysed from May 2013 to December 2017. Clinical results were analysed and compared between the two groups and represented as a learning curve. Mean follow up was 36.2 months ± 11.8. Results: This study found a significant difference in complications between the senior and junior surgeons for operating time, infection rate, and lateral femoral cutaneous nerve (LFCN) neuropraxia. A trainee’s learning curve was an average of 10 DAA procedures before matching the senior surgeon. Of note, the early complications correlated with intraoperative fractures increased with experience in both groups. Operating time for the senior equalised after 70 cases. Dislocation rate and limb length discrepancy were excellent and did not show a learning curve between the two groups. Conclusion: DAA is a safe approach to implant a THA. There is a learning curve and initial supervision is recommended for both seniors and trainees. Level of evidence: Retrospective, consecutive case series; level IV.

scholarly journals Management of Infected Pancreatic Necrosis—The “Step Up” Approach and Minimal Access Retroperitoneal Pancreatic Necrosectomy

2014 ◽  
Vol 77 (S1) ◽  
pp. 125-127 ◽  
Author(s):  
B. Joseph John ◽  
S. Swaminathan ◽  
L. VenkataKrishnan ◽  
G. S. Singh ◽  
G. Krishnaveni ◽  
...  
Keyword(s):  
Pancreatic Necrosis ◽  
Infected Pancreatic Necrosis ◽  
Minimal Access ◽  
Pancreatic Necrosectomy

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 Immune enhancement to prevent infected pancreatic necrosis: A double-blind randomized controlled trial

2021 ◽  
Author(s):  
Lu Ke ◽  
Jing Zhou ◽  
Wenjian Mao ◽  
Tao Chen ◽  
Yin Zhu ◽  
...  
Keyword(s):  
Pancreatic Necrosis ◽  
Controlled Trial ◽  
Necrotizing Pancreatitis ◽  
Infected Pancreatic Necrosis ◽  
Index Admission ◽  
Apache Ii Score ◽  
Double Blind ◽  
Gastrointestinal Fistula ◽  
Immune Enhancement ◽  
To Receive

BACKGROUND&AIMS Infected pancreatic necrosis (IPN) is a highly morbid complication of acute pancreatitis(AP). Since there is evidence of immunosuppression in the early phase of AP, immune enhancement using Thymosin alpha 1 (Tα1), which stimulates both innate and adaptive immunity, may be a therapeutic strategy to prevent IPN. Our aim was to assess the efficacy of early Tα1 treatment on the development of IPN. METHODS We conducted a multicenter, randomized, double-blind, placebo-controlled trial in patients with predicted severe acute necrotizing pancreatitis (ANP). ANP patients with an APACHE II score≥8 admitted within seven days of the advent of symptoms were considered eligible. Enrolled patients were assigned to receive a subcutaneous injection of Tα1 1.6 mg, every 12 hours for the first 7 days and 1.6 mg once a day for the subsequent 7 days or matching placebo (normal saline). The primary outcome was the development of IPN during the index admission. RESULTS From Mar 2017 through Dec 2020, 508 patients were randomized at 16 hospitals, of whom 254 were assigned to receive Tα1 and 254 placebo. During the index admission, 40/254 (15.7%) patients in the Tα1 group developed IPN compared with 46/254 patients (18.1%) in the placebo group (difference -2.4% [95%CI -7.4% to 5.0%]; p=0.47). The results were similar in four predefined subgroups. There was no difference in other major complications, including new-onset organ failure (10.6% vs. 15.0%; p=0.15), bleeding (6.3% vs. 3.5%; p=0.15), and gastrointestinal fistula (2.0% vs. 2.4%; p=0.75) during the index admission. CONCLUSIONS The immune-enhancing Tα1 treatment of patients with predicted severe ANP did not reduce the incidence of IPN during the index admission.

scholarly journals Surgery in the Treatment of Acute Pancreatitis Minimal Access Pancreatic Necrosectomy

2005 ◽  
Vol 94 (2) ◽  
pp. 135-142 ◽  
Author(s):  
S. Connor ◽  
M. G. T. Raraty ◽  
N. Howes ◽  
J. Evans ◽  
P. Ghaneh ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Mortality Rate ◽  
Open Surgery ◽  
Pancreatic Necrosis ◽  
Statistical Significance ◽  
Infected Pancreatic Necrosis ◽  
Current Evidence ◽  
Minimal Access ◽  
Randomised Controlled ◽  
Invasive Techniques

Between 5% and 10% of patients with acute pancreatitis will develop infected pancreatic necrosis. Traditional open surgery for this condition carries a mortality rate of up to 50%, and therefore a number of less invasive techniques have been developed, including radiological drainage and a minimal access retroperitoneal approach. No randomised controlled trials have been published which compare these techniques. Indications for minimal access surgery are the same as for open surgery, i.e. infected pancreatic necrosis or failure to improve with extensive sterile necrosis. Access is obtained to the pancreatic necrosis via the left loin and necrosectomy performed using an operating nephroscope, and this often requires several procedures to remove all necrotic tissue. The cavity is continuously irrigated on the ward in between procedures. The results of this approach are encouraging, with less systemic upset to the patient, a lower incidence of post-operative organ failure when compared with open surgery, and a reduced requirement for ITU support. There is also a trend towards a lower mortality rate, although this does not reach statistical significance on the data published so far. Current evidence suggests that a minimal access approach to pancreatic necrosis is feasible, well tolerated and beneficial for the patient when compared with open surgery.

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.

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