Comparison between minimally invasive and open surgical treatment in necrotizing pancreatitis

Wroński, Marek; Cebulski, Włodzimierz; Witkowski, Bartosz; Jankowski, Mieczysław; Kluciński, Andrzej; Krasnodębski, Ireneusz W.; Słodkowski, Maciej

doi:10.1016/j.jss.2016.10.022

Cited by 31 publications

(25 citation statements)

References 34 publications

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“…Most commonly in the studies either mortality and/or major postoperative complications constitute the primary outcome (often in form of a composite outcome). Common complications include pancreatic fistula, haemorrhage, sepsis, new onset organ failure and type 3c diabetes, as well as incisional hernias and infection of the wound [20,32,33,34,35,36]. Secondary outcomes include the length of hospital stay, length of ICU stay, number of interventions performed and the cost of overall patient management [32][33][34][35][36][37][38].…”

Section: Outcomes and Complicationsmentioning

confidence: 99%

“…A small percutaneous route toward the necrotic collection is established, which is then dilated to allow for full lavage and debridement [51]. A variation of VARD which is also used is Minimal Access Retroperitoneal Pancreatic Necrosectomy (MARPN); it does not utilise camera assistance but follows the same principle, as far as debridement is concerned [20,52]. Similar to ETN and VARD, the choice for this method is predominantly determined by the location of the necrotic collection [53].…”

Section: Videoscope-assisted Retroperitoneal Approach (Vard)mentioning

confidence: 99%

“…The efficacy of 'step-up' protocols was investigated in the PANTER study in 2010 and since then multiple step-up protocols were suggested and investigated [38]. When compared with open necrosectomy, step-up reduces the length of hospital stay [20,37]. The reports on reduced mortality are variable but generally step-up performs better or noninferiorly compared to open necrosectomy [20,32,37,38].…”

Section: Step-up Approachesmentioning

confidence: 99%

“…When compared with open necrosectomy, step-up reduces the length of hospital stay [20,37]. The reports on reduced mortality are variable but generally step-up performs better or noninferiorly compared to open necrosectomy [20,32,37,38]. In his 2014 study, Bang et al compared an endoscopic step-up procedure with an 'algorithmic' approach, which (based on certain patient criteria) assessed the most suitable intervention and found that the algorithmic approach outperformed standardised step-up protocols with a success rate of 91% to 60% [57].…”

Section: Step-up Approachesmentioning

confidence: 99%

“…Historically, open necrosectomy was a surgical management option for necrotising pancreatitis, however, the standards of surgical treatment have changed in recent years, with open surgery giving way to less invasive management options. Currently, there is no consensus on the best approach for severe necrotising pancreatitis (SNP) and the choice is primarily based on the experience of the surgeons, availability of the equipment and preference of the centre [12,15,17,20]. Commonly employed methods include open necrosectomy, percutaneous drainage (PD), endoscopic transluminal necrosectomy (ETN) video-assisted retroperitoneal debridement (VARD) and other minimally-invasive surgical variants including percutaneous necrosectomy [21].…”

Section: Introductionmentioning

confidence: 99%

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Managing Acute Severe Necrotising Pancreatitis

Kawka¹,

Gall²,

Jiao³

2019

obm hg

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Background: Severe necrotising pancreatitis (SNP) is characterised by high mortality, severe complications and a poor prognosis despite progress in the understanding of the aetiology and progression of the disease. Traditionally, necrotic changes were removed by open necrosectomy but the paradigm has shifted towards more conservative management and minimally-invasive surgical procedures. However, there is still no consensus on the best management pathway. Minimally-invasive procedures such as percutaneous drainage, endoscopic transluminal necrosectomy, video-assisted retroperitoneal debridement (VARD) and other minimally-invasive surgical variants including percutaneous necrosectomy, as well as step-up protocols (less invasive procedure followed by a more invasive procedure if needed) have all been suggested as potential replacements of open necrosectomy. Methods: A literature search was conducted in PubMed database to look for comparative studies (RCTs, case series and pooled analyses) between two or more surgical techniques utilised for SNP management. Studies were limited to the last 10 years; retrospective studies were restricted by the number of cases (min. 50). Only management of necrotic collections was taken intro considerations.

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Section: Outcomes and Complicationsmentioning

confidence: 99%

Section: Videoscope-assisted Retroperitoneal Approach (Vard)mentioning

confidence: 99%

Section: Step-up Approachesmentioning

confidence: 99%

Section: Step-up Approachesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Managing Acute Severe Necrotising Pancreatitis

Kawka¹,

Gall²,

Jiao³

2019

obm hg

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Endoscopic and surgical treatment of necrotizing pancreatitis—a comparison of short- and long-term outcome

Timmermann,

Schönauer,

Hillebrandt

et al. 2024

Langenbecks Arch Surg

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Background Acute necrotizing pancreatitis is still related to high morbidity and mortality rates. Minimal-invasive treatment options, such as endoscopic necrosectomy, may decrease peri-interventional morbidity and mortality. This study aims to compare the initial operative with endoscopic treatment on long-term parameters, such as endocrine and exocrine functionality, as well as mortality and recurrence rates. Methods We included 114 patients, of whom 69 were treated with initial endoscopy and 45 by initial surgery. Both groups were further assessed for peri-interventional and long-term parameters. Results In the post-interventional phase, patients in the group of initial surgical treatment (IST) showed significantly higher rates of renal insufficiency (p < 0.001) and dependency on invasive ventilation (p < 0.001). The in-house mortality was higher in the surgical group, with 22% vs. 10.1% in the group of patients following initial endoscopic treatment (IET; p = 0.077). In long-term follow-up, the overall mortality was 45% for IST and 31.3% for IET (p = 0.156). The overall in-hospital stay and intensive care unit (ICU) stay were significantly shorter after IET (p < 0.001). In long-term follow-up, the prevalence of endocrine insufficiency was 50% after IST and 61.7% after IET (p = 0.281). 57.1% of the patients following IST and 16.4% of the patients following IET had persistent exocrine insufficiency at that point (p = < 0.001). 8.9% of the IET and 27.6% of the IST patients showed recurrence of acute pancreatitis (p = 0.023) in the long-term phase. Conclusion In our cohort, an endoscopic step-up approach led to a reduced in-hospital stay and peri-interventional morbidity. The endocrine function appeared comparable in both groups, whereas the exocrine insufficiency seemed to recover in the endoscopic group in the long-term phase. These findings advocate for a preference for endoscopic treatment of acute necrotizing pancreatitis whenever feasible.

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