A Conservative and Minimally Invasive Approach to Necrotizing Pancreatitis Improves Outcome

Santvoort, Hjalmar C. van; Bakker, Olaf J.; Bollen, Thomas L.; Besselink, Marc G.; Ali, Usama Ahmed; Schrijver, A. Marjolein; Boermeester, Marja A.; Goor, Harry van; Dejong, Cornelis H. C.; Eijck, Casper H. van; Ramshorst, Bert van; Schaapherder, Alexander F.; Harst, Erwin van der; Hofker, Sijbrand; Nieuwenhuijs, Vincent B.; Brink, Menno A.; Kruyt, Philip M.; Manusama, Eric R.; Schelling, George P. van der; Karsten, Tom; Hesselink, E. J.; Laarhoven, Cornelis J. van; Rosman, Camiel; Bosscha, K.; Wit, Ralph J. de; Houdijk, Alexander P. J.; Cuesta, Miguel A.; Wahab, Peter J.; Gooszen, Hein G.

doi:10.1053/j.gastro.2011.06.073

Cited by 640 publications

(459 citation statements)

References 51 publications

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“…Th e DPSG cohort consisted of AP patients admitted to any one of the 15 collaborating Dutch hospitals (8 university and 7 major teaching hospitals) from 2004 to 2007 (25)(26)(27). Patients with an initial AP episode were initially screened for participation in a randomized controlled trial evaluating the use of probiotics in severe AP (PROPATRIA trial, registration No.…”

Section: Study Design and Patient Populationmentioning

confidence: 99%

Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases

Koutroumpakis

Bakker

et al. 2015

American Journal of Gastroenterology

131

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Section: Study Design and Patient Populationmentioning

confidence: 99%

Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases

Koutroumpakis

Bakker

et al. 2015

American Journal of Gastroenterology

131

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“…10,11,15,16 First-line methods were US-guided procedures, which included transcutaneous and endoscopically performed punctures and drains. 17,18 While performing the treatment puncture, we removed the content of the pathological foci at most, repeatedly washed the cavities with antiseptic solutions, including ozonized isotonic and povidone-iodine solutions. If the pathological focus contained a lot of detritus, it was drained using the Seldinger technique by installing large diameter silicone drains.…”

Section: Discussionmentioning

confidence: 99%

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

Khomiak¹,

Rotar

Tereshkevich³

et al. 2017

Int Surg J

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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.

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“…Organisms implicated are usually gram-negative rods (e.g., Escherichia coli, Klebsiella and Pseudomonas spp.) and Enterococcus species [2,21]. Infection is suspected in patients with prolonged fever, elevated WBC count, or progressive clinical deterioration despite adequate medical therapy.…”

Section: Detection Of Infectionmentioning

confidence: 99%

“…Infection is suspected in patients with prolonged fever, elevated WBC count, or progressive clinical deterioration despite adequate medical therapy. CECT can confirm the diagnosis by showing intra-pancreatic or peri-pancreatic air, but it is a rare finding [2,21]. Image guided percutaneous Fineneedle aspiration (FNA) should be done for Gram's stain and culture in suspected infective necrosis.…”

Section: Detection Of Infectionmentioning

confidence: 99%

Pancreatic Necrosis: A Challenging Complication of Acute Pancreatitis

Singh

Kathuria

Saxena

et al. 2018

ICPJL

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A Conservative and Minimally Invasive Approach to Necrotizing Pancreatitis Improves Outcome

Cited by 640 publications

References 51 publications

Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases

Admission Hematocrit and Rise in Blood Urea Nitrogen at 24 h Outperform other Laboratory Markers in Predicting Persistent Organ Failure and Pancreatic Necrosis in Acute Pancreatitis: A Post Hoc Analysis of Three Large Prospective Databases

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

Pancreatic Necrosis: A Challenging Complication of Acute Pancreatitis

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