Surgical management of acute necrotizing pancreatitis: a 13-year experience and a systematic review

Practice Guidelines in Acute Pancreatitis

“…One possible explanation is that there is considerable variation in the number of patients with severe necrotizing pancreatitis who are referred to individual hospitals for specialized care. In recent series, among the total number of patients with severe pancreatitis who were cared for in referral hospitals, the median percentage of referred patients was 63% (range 32-73%) (55,60,62,64,68,83,106,110,138,156,161,164). In some series (60,62,68), but not all (83,138), patients who were transferred were more seriously ill than those who were admitted directly to the reporting hospital.…”

“…The mortality in the absence of organ failure is 0 (50,66,68,83), with single organ failure is 3% (range 0-8%) (66,83,163), with multisystem organ failure 47% (range 28-69%) (48,66,68,83,120,163,164).…”

“…The types of surgery that have generally been recommended have included necrosectomy with closed continuous irrigation via indwelling catheters (47,55,89,104,110,112,119,156,164,169), necrosectomy and open packing (89,104,116,119,156,164,169), or necrosectomy with closed drainage without irrigation (89, 106). There have not been randomized prospective trials comparing these procedures.…”

Endoscopic transmural drainage combined with percutaneous drainage in treatment of walled-off pancreatic necrosis-case report

“…Applied procedures of open necrosectomies are found to be burdened with high morbidity and mortality. [4][5][6] Due to the development of minimally invasive techniques of treatment of pancreatic necrosis the access to the necrotic collection is possible through transperitoneal, retroperitoneal, transmural and transpapillary way. [7,8] The optimal strategy in many patients is joining a few minimally invasive methods, which allows multiplexing of access to the collection.…”

Minimally Invasive Management of Acute Necrotizing Pancreatitis

“…Necrotizing pancreatitis is the most severe form of acute pancreatitis associated with high morbidity and mortality due to the development of infected pancreatic necrosis, and multisystem organ failure. In severe necrotizing pancreatitis, the mortality rate ranges from 10% to 40%, and it is especially high (up to 50%) when the necrosis is infected and progressing to sepsis and multiorgan failure [1][2][3]7]. The appropriate treatment of infected pancreatic necrosis remains the subject of much debate.…”