Outcomes From Minimal Access Retroperitoneal and Open Pancreatic Necrosectomy in 394 Patients With Necrotizing Pancreatitis

Gomatos, Ilias P.; Halloran, Christopher; Ghaneh, Paula; Raraty, Michael; Polydoros, Fotis; Evans, Jonathan; Smart, Howard; Yagati-Satchidanand, Rajesh; Garry, Jo; Whelan, Philip; Hughes, Faye; Sutton, Robert; Neoptolemos, John P.

doi:10.1097/sla.0000000000001407

Cited by 101 publications

(84 citation statements)

References 48 publications

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“…This meta-analysis, however, suffered from significant heterogeneity. Another single-centre study compared 274 patients undergoing minimally invasive surgical necrosectomy with 120 patients undergoing open necrosectomy; mortality was 15% vs 23% (p=0.06) 12. Our study, with individual patient data, differed from these earlier studies because of its much larger sample size, and as a consequence the possibility to analyse different risk groups and to adjust for the effects of confounding and selection bias.…”

Section: Discussionmentioning

confidence: 89%

Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients

Brunschot

Hollemans

Bakker

et al. 2017

Gut

110

113

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Section: Discussionmentioning

confidence: 89%

Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients

Brunschot

Hollemans

Bakker

et al. 2017

Gut

110

113

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“…The traditional approach is open necrosectomy with closed packing,16 repeat debridement (Figure 1), or continuous lavage. Modern alternatives include laparoscopic transperitoneal necrosectomy,17 video-assisted retroperitoneal debridement (VARD) (Figure 2),18 endoscopic necrosectomy,19 percutaneous drainage, and step-up or hybrid approaches 20,21…”

Section: Minimize Invasivenessmentioning

confidence: 99%

Necrotizing pancreatitis: challenges and solutions

Bendersky¹,

Mallipeddi²,

Perez³

et al. 2016

CEG

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Acute pancreatitis is a common disease that can progress to gland necrosis, which imposes significant risk of morbidity and mortality. In general, the treatment for pancreatitis is a supportive therapy. However, there are several reasons to escalate to surgery or another intervention. This review discusses the pathophysiology as well as medical and interventional management of necrotizing pancreatitis. Current evidence suggests that patients are best served by delaying interventions for at least 4 weeks, draining as a first resort, and debriding recalcitrant tissue using minimally invasive techniques to promote or enhance postoperative recovery while reducing wound-related complications.

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“…The treatment of PFCs has evolved considerably over the past decade, moving from what was once open surgical management to increasingly minimally invasive techniques, both by surgery and by endoscopy. High rates of complications (64%–95%) and mortality (15%–40%) with surgical treatment of PFCs has spurred the increasing adoption of endoscopic techniques for PFC drainage and debridement [1]. Randomized controlled trials (RCT) have confirmed that an endoscopic approach is safer and associated with lower costs, shorter hospital stay and improved quality of life compared to surgery [2].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Ultrasound-Guided Management of Pancreatic Fluid Collections: Update and Review of the Literature

et al. 2017

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Severe acute pancreatitis is often complicated by the development of pancreatic fluid collections (PFCs), which may be associated with significant morbidity and mortality. It is crucial to accurately classify these collections as a pseudocyst or walled-off necrosis (WON) given significant differences in outcomes and management. Interventions for PFCs have increasingly shifted to less invasive strategies, with endoscopic ultrasound (EUS)-guided methods being shown to be safer and equally effective as more invasive surgical techniques. In recent years, many new developments have improved the safety and efficacy of EUS-guided interventions, such as the introduction of lumen-apposing metal stents (LAMS), direct endoscopic necrosectomy (DEN) and multiple other adjunctive techniques. Despite these developments, treatment of PFCs, and infected WON in particular, continues to be associated with significant morbidity and mortality. In this article, we discuss the EUS-guided management of PFCs while reviewing the latest developments and controversies in the field. We end by summarizing our own approach to managing PFCs.

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Outcomes From Minimal Access Retroperitoneal and Open Pancreatic Necrosectomy in 394 Patients With Necrotizing Pancreatitis

Abstract: Increasing experience and advances in perioperative care have led to improvement in outcomes. The role of MARPN in reducing complications and deaths within a multimodality approach remains substantial and should be used initially if feasible.

Cited by 101 publications

References 48 publications

Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients

Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients

Necrotizing pancreatitis: challenges and solutions

Endoscopic Ultrasound-Guided Management of Pancreatic Fluid Collections: Update and Review of the Literature

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