scholarly journals Comparison of open pancreatic necrosectomy with step-up minimally invasive approach as surgical treatment of patients with acute necrotizing pancreatitis

2017 ◽  
Vol 4 (8) ◽  
pp. 2502
Author(s):  
Ihor V. Khomiak ◽  
Oleksandr V. Rotar ◽  
Ivan S. Tereshkevych ◽  
Vasyl I. Rotar ◽  
Andrii I. Khomiak ◽  
...  
Keyword(s):  
Invasive Surgery ◽  
Necrotizing Pancreatitis ◽  
Disease Onset ◽  
Acute Necrotizing Pancreatitis ◽  
Surgical Approaches ◽  
Control Group ◽  
Study Group ◽  
Invasive Approach ◽  
Number Of Patients ◽  
Acute Necrotizing

Background: Recent experimental and clinical researches improves our understanding of natural course of acute necrotizing pancreatitis and mechanisms of its complications development. Today there are no disagreements on the issue of timing and main indications for surgery of ANP, but different surgical approaches still exist.Methods: The analysis of treatment of 226 patients with acute necrotizing pancreatitis has been performed. The study group included 116 patients in whom consequently diapeutic methods, endoscopic and lumbotomic video-controlled pancreatic necrsequesterectomy, minilaparo and lumbotomy, in case of their insufficiency- “open” interventions on pancreas were applied. In 110 persons of the control group traditional surgical tactic with application of laparotomic procedures was used.Results: Sequential (step-up) implementation of mini-invasive surgery allowed to reduce the number of open wide operations by 3.4 times (p <0,05) and to postpone their performance: 85% of operations in the study group were performed after 4 weeks of the disease onset, in the control group only 33% (p <0,05). Compared with the control group the level of the first diagnosed OF after the surgery was significantly lower in patients undergoing preliminary mini-invasive surgery (12.5% versus 28.2%, p <0.05), the number of patients requiring prolonged intensive care after the surgery was significantly lower (17.5% versus. 38.2%, p <0.05). 4 patients of the study group died (versus 26 in the control group р<0,05).Conclusions: Application of step-up individualized approach in patients with acute necrotizing pancreatitis ensures a decrease in the number of laparotomic pancreatic necrosectomies and allows to postpone "open" operations for the period after the 4th week of disease onset which is accompanied by reduction of the incidence of postoperative organ failure and mortality.

scholarly journals EXTRAPANCREATIC INFECTION AS A RISK FACTOR FOR ANTIBIOTIC RESISTANCE OF PANCREATIC INFECTIOUS AGENTS IN PATIENTS WITH ACUTE NECROTIZING PANCREATITIS

2020 ◽  
Vol 2 (12) ◽  
pp. 71-78
Author(s):  
O. Dronov ◽  
I. Kovalska ◽  
A. Horlach ◽  
I. Shchyhel
Keyword(s):  
Risk Factor ◽  
Necrotizing Pancreatitis ◽  
Acute Necrotizing Pancreatitis ◽  
Control Group ◽  
Infectious Agents ◽  
Bacterial Strains ◽  
Retrospective Case ◽  
Pancreatic Infection ◽  
Positive Bacterial Culture ◽  
Acute Necrotizing

Aim of the study To determine the effect of extrapancreatic infection (EPI) on antibacterial resistance of pancreatic infectious agents in patients with acute infected necrotic pancreatitis Materials and Methods A longitudinal retrospective case-control study was conducted. The Object of the study were the patients with infected acute necrotizing pancreatitis (ANP). The subject of the study was the acquired AMR of pancreatic infection (PI) agents in patients with ANP. The control group included 27 patients who had a positive bacterial culture from sources of PI. 21 patients were included in the risk group, in which the additional source of EPI was recorded. Bacteriological monitoring was conducted in two stages: the primary identification of the agent of PI and the completion of inpatient treatment. Microbiological identification of the pathogen of EPI was performed before the primary determination of the pathogen of PI, and in the interval between stages I and II of the study. According to the results of the resistance profile of PI to AMR, all patients were divided into four clusters: I - patients who identified only antibiotic-sensitive bacterial strains (AMR"-"), II - patients with defined MDR-bacteria (multidrug-resistant), III - patients with XDR-bacteria (extensively drug-resistant), IV - patients with PDR bacteria (pandrug-resistant). Results The presence of EPI in patients with ANP influences the development of AMRs of PI toward increasing XDR and PDR strains (p=0.008 and p=0.04, respectively). In patients with infected ANP with the EPI, the risk of developing XDR infection was 2.4 times higher than the risk of developing this level of AMR in patients with no EPI (RR-2.4 (95% CI-1.16-4.91), p=0.03). EPI increases the risk of PDR PI by 8 times (RR-8.0 (95% CI-1.04-61.5) p=0.04). For each patient with infected ANP with signs of EPI, the risk of developing XDR strains was 36%, and PDR strains - 25%. Conclusions The presence of extrapancreatic sources of infection is a risk factor for development of AMR strains of microorganisms that persist in the sources of pancreatic infection. In this category of patients the risk of identification of extensively resistant strains was increased by 2.4-fold (p=0.03) and PDR strains by 8-fold (p=0.04), compared with patients with infected ANP without EPI.

Characterization of a new acute necrotizing pancreatitis model induced by L-ornithine

2008 ◽  
Vol 46 (05) ◽  
Author(s):  
G Biczó ◽  
P Hegyi ◽  
S Dósa ◽  
B Iványi ◽  
K Jármay ◽  
...  
Keyword(s):  
Necrotizing Pancreatitis ◽  
Acute Necrotizing Pancreatitis ◽  
Acute Necrotizing
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