Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique

Tsiotos, Gregory G.; León, Enrique Luque-de; Søreide, Jon Arne; Bannon, Michael P.; Zietlow, Scott P.; Baerga-Varela, Yvonne; Sarr, Michael G.

doi:10.1016/s0002-9610(97)00277-8

Cited by 152 publications

(93 citation statements)

References 31 publications

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“…In addition to the effects of TPN on gut immune surveillance, TPN introduces a potential source of gram-positive and fungal infection [31]. Currently, these pathogens have become much more common isolates in necrotizing pancreatitis [2, 32], possibly related to the use of TPN or use of prophylactic broad-spectrum antibiotics during the first weeks of onset of pancreatitis.…”

Section: Bowel Rest/parenteral Nutritionmentioning

confidence: 99%

“…Overall mortality rates are low (<5%), but the mortality rate of those patients with severe AP, which comprise 5–10% of all patients with AP, remains about 10–20% [1, 2, 3, 4]. Mortality in severe AP has two peaks, the first caused by the overwhelming (noninfective) systemic inflammatory response syndrome (SIRS) which develops during the first week of illness, and the second caused by infection and bacteremia beginning 1–3 weeks after onset of AP.…”

Section: Introductionmentioning

confidence: 99%

“…Mortality in severe AP has two peaks, the first caused by the overwhelming (noninfective) systemic inflammatory response syndrome (SIRS) which develops during the first week of illness, and the second caused by infection and bacteremia beginning 1–3 weeks after onset of AP. This second peak, related to pancreatic and peripancreatic superinfection, is responsible for up to 80% of the mortality in severe AP [2, 5]. …”

Section: Introductionmentioning

confidence: 99%

“…Recent interest has focused on prophylactic antibiotics, either given systemically to sterilize the blood or given enterically to ‘decontaminate’ the gut, but each designed to prevent pancreatic superinfection [1, 2, 3, 4, 6, 7, 8, 9]. Another approach, the focus of this review, might be to prevent and/or reverse breakdown of the mucosal defense barrier with provision of enteral as opposed to parenteral nutrition.…”

Section: Introductionmentioning

confidence: 99%

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Early Enteral Feeding in Severe Acute Pancreatitis: Can It Prevent Secondary Pancreatic (Super) Infection?

Lehocky

Sarr

2000

Dig Surg

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Sepsis continues to account for a second peak in mortality in patients with severe acute pancreatitis. The prevention of these septic complications and subsequent development of multiple organ dysfunction syndrome remains a major focus for investigators, yet despite considerable clinical and experimental work addressing its etiology, septic complications remain high. Several studies have been designed to demonstrate the mechanism of origin of these septic complications with an attempt to define strategies for their prevention to improve patient outcomes. There is clear evidence that the origin of this secondary bacterial infection arises from enteric bacterial translocation secondary to disruption of the gut mucosal barrier during acute pancreatitis. Strategies designed to prevent secondary pancreatic infection include aggressive fluid resuscitation to maximize organ perfusion, early systemic antibiotic treatment or selective gut decontamination, and recently attempts to block mediators of the systemic inflammatory response. This discussion will summarize our present understanding of the etiopathogenesis of secondary bacterial ‘superinfection’ of necrotizing pancreatitis and how the initiation of enteral feeding early in the course of acute pancreatitis may prove to be an effective means of preventing and/or reversing the breakdown of the gut mucosal defense barrier.

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Section: Bowel Rest/parenteral Nutritionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Early Enteral Feeding in Severe Acute Pancreatitis: Can It Prevent Secondary Pancreatic (Super) Infection?

Lehocky

Sarr

2000

Dig Surg

Self Cite

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“…Despite considerable improvement in the treatment of severe acute pancreatitis (SAP), the mortality of the disease still ranges between 15-25% [1][2][3] . Multiple organ dysfunction syndrome (MODS) [4][5][6][7] , the extent of necrotic pancreatic parenchyma and the presence of bacterial infection have been identified as major determinants for death [8,9] .…”

Section: Introductionmentioning

confidence: 99%

Clinical characteristics and management of patients with early acute severe pancreatitis: Experience from a medical center in China

Tao¹,

Zhang²,

Zou³

2004

WJG

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AIM:To study clinical characteristics and management of patients with early severe acute pancreatitis (ESAP). METHODS:Data of 297 patients with severe acute pancreatitis (SAP) admitted to our hospital within 72 h after onset of symptoms from January 1991 to June 2003 were reviewed for the occurrence and development of early severe acute pancreatitis (ESAP). ESAP was defined as presence of organ dysfunction within 72 h after onset of symptoms. Sixtynine patients had ESAP, 228 patients without organ dysfunction within 72 h after onset of symptoms had SAP. The clinical characteristics, incidence of organ dysfunction during hospitalization and prognosis between ESAP and SAP were compared.RESULTS: Impairment degree of pancreas (Balthazar CT class) in ESAP was more serious than that in SAP (5.31±0.68 vs 3.68±0.29, P<0.01). ESAP had a higher mortality than SAP (43.4% vs 2.6%, P<0.01), and a higher incidence of hypoxemia (85.5% vs 25%, P<0.01), pancreas infection (15.9% vs 7.5%, P<0.05), abdominal compartment syndrome (ACS) (78.3% vs 23.2%, P<0.01) and multiple organ dysfunction syndrome (MODS)(78.3% vs 10.1%, P<0.01). In multiple logistic regression analysis, the main predisposing factors to ESAP were higher APACHE II score, Balthazar CT class, MODS and hypoxemia. CONCLUSION:ESAP is characterised by MODS, severe pathological changes of pancreas, early hypoxemia and abdominal compartment syndrome. Given the poor prognosis of ESAP, these patients should be treated in specialized intensive care units with special measures such as close supervision, fluid resuscitation, improvement of hypoxemia, reduction of pancreatic secretion, elimination of inflammatory mediators, prevention and treatment of pancreatic infections.Tao HQ, Zhang JX, Zou SC. Clinical characteristics and management of patients with early acute severe pancreatitis: Experience from a medical center in China. World J Gastroenterol 2004; 10(6): 919-921

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Timing of Surgical Intervention in Necrotizing Pancreatitis

Verwer²,

et al. 2007

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To determine the effect of timing of surgical intervention for necrotizing pancreatitis. Design: Retrospective study of 53 patients and a systematic review. Setting: A tertiary referral center. Main Outcome Measure: Mortality. Results: Median timing of the intervention was 28 days. Eighty-three percent of patients had infected necrosis and 55% had preoperative organ failure. The mortality rate was 36%. Sixteen patients were operated on within 14 days of initial admission, 11 patients from day 15 to 29, and 26 patients on day 30 or later. This latter group received preoperative antibiotics for a longer period (PϽ.001), and Candida species and antibiotic-resistant organisms were more often cultured from the pancreatic or peripancreatic necrosis in these patients (P=.02). The 30-day group also had the lowest mortality (8% vs 75% in the 1 to 14-days group and 45% in the 15 to 29days group, PϽ.001); this difference persisted when outcome was stratified for preoperative organ failure. During the second half of the study, necrosectomy was further postponed (43 vs 20 days, P = .06) and mortality decreased (22% vs 47%, P=.09). We also reviewed 11 studies with a total of 1136 patients. Median surgical patient volume was 8.3 patients per year (range, 5.3-15.6), median timing of surgical intervention was 26 days (range, 3-31), and median mortality was 25% (range, 6%-56%). We observed a significant correlation between timing of intervention and mortality (R=−0.603; 95% confidence interval, −2.10 to −0.02; P =.05). Conclusion: Postponing necrosectomy until 30 days after initial hospital admission is associated with decreased mortality, prolonged use of antibiotics, and increased incidence of Candida species and antibioticresistant organisms.

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Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique

Cited by 152 publications

References 31 publications

Early Enteral Feeding in Severe Acute Pancreatitis: Can It Prevent Secondary Pancreatic (Super) Infection?

Early Enteral Feeding in Severe Acute Pancreatitis: Can It Prevent Secondary Pancreatic (Super) Infection?

Clinical characteristics and management of patients with early acute severe pancreatitis: Experience from a medical center in China

Timing of Surgical Intervention in Necrotizing Pancreatitis

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