Risk factors for morbidity in walled-off pancreatic necrosis and performance of the continuous postoperative lavage: a single center experience

Abstract

BACKGROUND:The aim of this study was to evaluate the risk factors for morbidity in cases of walled-off pancreatic necrosis (WOPN) and the performance of continuous postoperative lavage (CPL) for patients who demonstrated resistance to a minimally invasive approach. METHODS:The study enrolled 19 of 28 consecutive patients with WOPN who underwent surgical treatment or an endoscopic necrosectomy at Sakarya University Education and Research Hospital. The patients were divided into 2 groups according to the length of time from the first diagnosis of acute pancreatitis (AP) (Group 1, n=19) to preoperation or endoscopic necrosectomy (Group 2) (n=19). All of the cases were retrospectively evaluated and compared in terms of demographic features, operative features, and complications. RESULTS:No statistically significant difference was found between the number of complications or the duration of hospital stay in terms of age, body mass index, size of the walled-off pancreatic necrosis, American Society of Anesthesiologists score, Ranson's criteria, operation time, and duration from AP to endoscopic necrosectomy or operation (p>0.05). Performance of an endoscopic necrosectomy was determined to be correlated with a decrease in the number of complications (B=-0.626, 95% confidence interval [CI]: -0.956 to -0.296; p<0.001), and when a high neutrophil-to-lymphocyte ratio (NLR) was detected at first admission, the number of complications was greater (B=0.032, 95% CI: 0.009-0.055; p=0.01). Reproduction in a culture and male gender were found to be risk factors for a prolonged hospital stay (B=0.669, 95% CI: 0.365-0.973; p<0.001), (B=0.484, 95% CI: 0.190-0.778; p=0.003), respectively. CONCLUSION: CPL is a safe and effective surgical treatment approach for WOPN. Reproduction in a culture, male gender, and a high NLR on first admission and a negative or not-available endoscopic necrosectomy were determined to be risk factors for a poor prognosis.

Intraoperative hemorrhage and increased spleen volume are risk factors for conversion to open surgery in patients undergoing elective robotic and laparoscopic splenectomy

“…We found that a spleen volume higher than 400 cm 3 increases the risk of conversion to open surgery 22.5 times. Secondly, intraoperative hemorrhage from the splenic hilum has a 61-fold risk of conversion Minimal invasive surgery, whether robotic or laparoscopic, has become popular due to less postoperative abdominal pain, shortened length of hospital stay, and early return to normal daily activity (1)(2)(3)(4)(5)(6)(7)(8). Robotic surgery surpasses laparoscopic technique by providing more articulation and maneuverability (7,8).…”

“…Minimal invasive surgery (MIS) is feasible and safe with growing popularity in different clinical practices (1)(2)(3)(4)(5). Laparoscopic and robotic splenectomies are subgroups of MIS and have been increased due to good exposure of the surgical field, less bleeding, postoperative abdominal pain and shorter length of the hospital stay (6)(7)(8).…”

Pancreaticojejunostomy anastomosis techniques after pancreaticoduodenectomy: a critical review

“…Pancreaticoduodenectomy (PD) or the Whipple procedure is a potentially curative treatment for carcinomas in the periampullary area, head, or processus uncinatus of the pancreas (2). However, the Whipple procedure is critical for both the surgeon and the patient, as resection of the organ and tissue, combined with the essential reconstruction involved, can lead to high complications and death (3).…”

Acute biliary pancreatitis during pregnancy and post delivery period

“…[1] Also, pregnancy is an exclusion criterion in some AP studies. [2] Cite this article as: Hot S, Eğin S, Gökçek B, Yeşiltaş M, Karakaş DÖ. Acute biliary pancreatitis during pregnancy and in the post-delivery period.…”

“…[10] Particularly, acute biliary pancreatitis related to pregnancy (ABPP) has a relatively high recurrence rate of 70% in pregnant women compared to the general population (20-30%). [2,6] For the management of ABPP, the physician should consider maternal and fetal risks associated with irradiation using endoscopic retrograde cholangiopancreatography (ERCP), imaging methods, medical treatment, general anesthesia, and surgery. Laparoscopic cholecystectomy (LC) reduces the morbidity of surgical treatment in ABPP patients.…”