Predictors of Surgery in Patients With Severe Acute Pancreatitis Managed by the Step-Up Approach

Babu, R; Gupta, Rajesh; Kang, Mandeep; Bhasin, Deepak K.; Rana, Surinder Singh; Singh, Rajinder

doi:10.1097/sla.0b013e318269d25d

Cited by 134 publications

(126 citation statements)

References 33 publications

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“…Also, management of infected or symptomatic collections needs interventions in the form of percutaneous drains or endoscopic/surgical necrosectomy/ drainage. 9,10 It is not clear if these interventions predispose to hemorrhagic complications in such patients. Systematic studies on gastrointestinal bleeding in acute pancreatitis are few and have not addressed the issue of intervention predisposing to occurrence of bleeding.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal bleeding in acute pancreatitis: etiology, clinical features, risk factors and outcome

Rana¹

2015

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Section: Discussionmentioning

confidence: 99%

Gastrointestinal bleeding in acute pancreatitis: etiology, clinical features, risk factors and outcome

Rana¹

2015

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“…Success of percutaneous drainage is directly Babu et al 23 showed that percutaneous drainage reverted sepsis in 62% of patients and 48% did not need necrosectomy. These authors described a high rate of success with only drainage, in relation to others in literature.…”

Section: Predictive Factors Of Success Of Percutaneous Drainagementioning

confidence: 99%

Management of infected pancreatic necrosis: state of the art

Rasslan

Novo

Bitran

et al. 2017

Rev. Col. Bras. Cir.

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Pancreatic necrosis occurs in 15% of acute pancreatitis. The presence of infection is the most important factor in the evolution of pancreatitis. The diagnosis of infection is still challenging. Mortality in infected necrosis is 20%; in the presence of organic dysfunction, mortality reaches 60%. In the last three decades, there has been a real revolution in the treatment of infected pancreatic necrosis. However, the challenges persist and there are many unsolved questions: antibiotic treatment alone, tomography-guided percutaneous drainage, endoscopic drainage, video-assisted extraperitoneal debridement, extraperitoneal access, open necrosectomy? A step up approach has been proposed, beginning with less invasive procedures and reserving the operative intervention for patients in which the previous procedure did not solve the problem definitively. Indication and timing of the intervention should be determined by the clinical course. Ideally, the intervention should be done only after the fourth week of evolution, when it is observed a better delimitation of necrosis. Treatment should be individualized. There is no procedure that should be the first and best option for all patients. The objective of this work is to critically review the current state of the art of the treatment of infected pancreatic necrosis.

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“…Die Mortalität wurde durch dieses sequenzielle Vorgehen nicht reduziert (19 vs. 16%). Babu et al [37] evaluierten in einer erst kürzlich erschienenen Studie dieses sequenzielle Vorgehen für 70 Patienten mit nekrotisierender Pankreatitis. 55% der Patienten konnten dabei lediglich mittels intensivmedizinischer Behandlung und interventionellen Drainagen behandelt werden.…”

Section: Spezielles Vorgehen Bei Bestimmten Krankheitsbildernunclassified

Grenzen des laparoskopischen Operierens bei abdomineller Sepsis

Keck¹,

Wellner²,

Tittelbach-Helmrich³

et al. 2013

Visc Med

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Hintergrund: Zahlreiche präklinische Daten weisen auf Vorteile des laparoskopischen Operierens auch bei abdomineller Sepsisquelle und septischem Patienten hin. Methode und Ergebnisse: Anhand derzeit verfügbarer Literatur betrachten wir die Möglichkeiten und Limitierungen laparoskopischen Operierens beim septischen Patienten mit abdominellem Fokus. Neben generellen Überlegungen werden im Speziellen das Vorgehen bei Appendizitis, Cholezystitis, perforiertem Ulkus, Sigmadivertikulitis und akuter Pankreatitis erörtert. Schlussfolgerungen: Erfahrene laparoskopische Chirurgen können die Sanierung der abdominellen Sepsisquelle bei Appendizitis, Cholezystitis, perforiertem Ulkus oder auch Sigmadivertikulitis sicher durchführen. Kombinationen aus interventionellen Techniken und minimal invasiven Operationen bieten insbesondere bei der perforierten Sigmadivertikulitis und bei infizierten Pankreasnekrosen innovative Ansätze, die derzeit in multizentrischen prospektiven Studien untersucht werden.

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Predictors of Surgery in Patients With Severe Acute Pancreatitis Managed by the Step-Up Approach

Abstract: PCD reversed sepsis in 62% and avoided surgery in 48% of the patients. Reversal of sepsis within a week of PCD, APACHE II score at first intervention (PCD), and organ failure within a week of the onset of disease could predict the need for surgery in the early course of disease.

Cited by 134 publications

References 33 publications

Gastrointestinal bleeding in acute pancreatitis: etiology, clinical features, risk factors and outcome

Gastrointestinal bleeding in acute pancreatitis: etiology, clinical features, risk factors and outcome

Management of infected pancreatic necrosis: state of the art

Grenzen des laparoskopischen Operierens bei abdomineller Sepsis

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