Managing Acute Severe Necrotising Pancreatitis

Abstract

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.