Early versus late necrosectomy in severe necrotizing pancreatitis

Mier, Juan; León, Enrique Luque-de; Castillo, Armando; Robledo, Felipe; Blanco, Roberto

doi:10.1016/s0002-9610(96)00425-4

Cited by 488 publications

(284 citation statements)

References 20 publications

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“…In at least one report, patients so treated had a very high mortality (138). Finally, in one randomized prospective trial that compared early to late surgery in a small number of patients with sterile necrosis, there was a trend to greater mortality among those operated on within 4 days (105).…”

Section: Treatment Guideline Vi: Treatment Of Sterile Necrosismentioning

confidence: 99%

Practice Guidelines in Acute Pancreatitis

Banks

Freeman

2006

Am J Gastroenterology

1,656

980

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Section: Treatment Guideline Vi: Treatment Of Sterile Necrosismentioning

confidence: 99%

Practice Guidelines in Acute Pancreatitis

Banks

Freeman

2006

Am J Gastroenterology

1,656

980

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“…The trend for early intervention was not persisted with. A randomised trial was prematurely closed because the mortality associated with early surgery (within 2-3 days) was doubled (56 versus 27 %) when compared with more delayed surgery (after 12 days) [20]. Open necrosectomy is most performed using a pancreas preserving technique with gentle finger blunt debridement of demarcated non-viable tissue ('pancreatic sequestrum') with the avoidance of formal pancreatic resections and a reduced risk of bleeding, fistulae and avoiding the removal of viable pancreatic tissue.…”

Section: Surgical Treatment Of Infected Acute Necrotic Collections Anmentioning

confidence: 99%

Surgery for Acute Pancreatitis

2015

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Surgery for acute pancreatitis has undergone significant changes over the last 3 decades. A better understanding of the pathophysiology has contributed to this, but the greatest driver for change has been the rise of less invasive interventions in the fields of laparoscopy, endoscopy and radiology. Surgery has a very limited role in the diagnosis of acute pancreatitis. The most common indication for intervention in acute pancreatitis is for the treatment of complications and most notably the treatment of infected walled off necrosis. Here, the step-up approach has become established, with prior drainage (either endoscopic or percutaneous) followed by delay for maturing of the wall and then debridement by endoscopic or minimally invasive surgical methods. Open surgery is only indicated when this approach fails. Other indications for surgery in acute pancreatitis are for the treatment of acute compartment syndrome, nono c c l u s i v e i n t e s t i n a l i s c h a e m i a a n d n e c r o s i s , enterocutaneous fistulae, vascular complications and pseudocyst. Surgery also has a role in the prevention of recurrent acute pancreatitis by cholecystectomy. Despite the more restricted role, surgeons have an important contribution to make in the multidisciplinary care of patients with complicated acute pancreatitis.

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“…[9] Mier et al has proved that conservative treatment in the early phase of acute necrotizing pancreatitis and intervention in the later phase can significantly decrease patients' mortality. [11] In 1996, Baron et al introduced the results of endoscopic treatment of 11 patients with WOPN. [12] After performing the stomy between the lumen of the necrotic collection and the lumen of the gastrointestinal tract in patients, 10 Fr endoprosthesis and 7 Fr nasocystic drains were inserted through the stomy into the cavity of necrosis in order to irrigate the WOPN.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic transmural drainage combined with percutaneous drainage in treatment of walled-off pancreatic necrosis-case report

Jagielski

Smoczyński

Studniarek

et al. 2016

CRIM

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Pancreatic necrosis and the necrosis of surrounding tissues are found to be local complications occurring in 15% of patients suffering from acute pancreatitis. Walled-off pancreatic necrosis (WOPN) is in fact pancreatic fluid collection surrounded by a well-defined wall and inclusive of liquefied necrosis and elements (debris) of necrotic tissues. Endotherapy is an efficient method of treatment for patients with symptomatic WOPN. Often single transmural access to the necrotic collection is sufficient. However, in some patients with infected WOPN, the application of an extra way of access to pancreatic necrosis is a must. In these particular patients the optimal strategy is joining a few minimally invasive methods, which allows multiplexing of access to the collection. Herein we described the case of treatment with the use of minimally invasive techniques in a patient suffering from an infected WOPN, in which the single transmural access to the necrotic collection appeared to be insufficient and the application of an extra way of access to pancreatic necrosis was necessary. Only joining together both minimally invasive techniques-transmural drainage and percutaneous drainage had become efficient enough and led to complete healing of the patient.

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Early versus late necrosectomy in severe necrotizing pancreatitis

Cited by 488 publications

References 20 publications

Practice Guidelines in Acute Pancreatitis

Practice Guidelines in Acute Pancreatitis

Surgery for Acute Pancreatitis

Endoscopic transmural drainage combined with percutaneous drainage in treatment of walled-off pancreatic necrosis-case report

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