Surgical strategies in the treatment of pancreatic necrosis and infection

D'Egidio, A; Schein, Moshe

doi:10.1002/bjs.1800780204

Cited by 106 publications

(46 citation statements)

References 43 publications

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“…It has been pointed out that in selected series of patients from specialised centres, aggressive investigation and surgical intervention can improve outcome in those with life-threatening infective complications [7]. General surgeons, however, have been shown to manage acute pancreatitis poorly, with, for example, low rates of CT performed in patients with pancreatic necrosis [1].…”

Section: Discussionmentioning

confidence: 99%

Non-Compliance with National Guidelines in the Management of Acute Pancreatitis in the United Kingdom

Aly

Milne

Johnson³

2002

Dig Surg

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Background: Deficiencies and lack of standardisation of the management of acute pancreatitis in the UK have been reported. National UK guidelines for the management of acute pancreatitis were published in 1998. However, implementation of national guidelines in other areas has been patchy, suggesting that evaluation of the uptake of the pancreatitis guidelines would be appropriate. Aim: Identification of current practice in the management of acute pancreatitis as reported by consultant surgeons, in order to determine how effectively the UK guidelines have been introduced into practice. Methods: A questionnaire was posted to 1,072 full members of the Association of Surgeons of Great Britain and Ireland. It consisted of 13 questions that aimed to identify the surgeon’s practice in the management of patients with acute pancreatitis in relation to key points in the UK guidelines. We compared the practice of hepatobiliary and pancreatic (HBP) vs. non-HBP specialists, and teaching vs. non-teaching hospital surgeons using the χ² test. Results: Of 538 responses (50%), 519 were from consultant surgeons. 59 did not look after patients with acute pancreatitis and 89 (17%) had a HBP interest. There were differences between the recommendations in the guidelines and reported practice, particularly in the use of critical care resources and referral to specialist units. Of consultants looking after acute pancreatitis 371 (72%) were non-HBP specialists. There were significant overall differences between the practice of HBP specialists and non-specialists: in severity assessment (Glasgow and C-reactive protein vs. Ranson criteria); indication and timing of requesting computed tomography (routinely at 7–10 days vs. when clinically indicated); nutritional support (enteral feeding vs. no support), and in common bile duct assessment prior to cholecystectomy (intra-operative cholangiography vs. endoscopic retrograde cholangiopancreatography). There was no significant difference between practice in teaching and non-teaching hospitals. Conclusion: Implementation of national guidelines for the management of acute pancreatitis was greater in the practice of HBP specialists than non-specialists. This has implications for the rationale of creating guidelines, and for the strategies associated with their introduction.

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Section: Discussionmentioning

confidence: 99%

Non-Compliance with National Guidelines in the Management of Acute Pancreatitis in the United Kingdom

Aly

Milne

Johnson³

2002

Dig Surg

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“…However, necrotising pancreatitis often requires surgical intervention and is associated with mortality rates ranging between 17.5 and 40% [3, 4]. Several important issues regarding the optimal management of patients with severe necrotising pancreatitis have been the subject of continuing debate [3, 4, 5]. These include the indications and timing for surgical intervention and the type of surgical procedure undertaken.…”

Section: Introductionmentioning

confidence: 99%

“…Fortunately, in more than two thirds of the patients the inflammatory process is mild and settles with nonspecific measures [2]. However, necrotising pancreatitis often requires surgical intervention and is associated with mortality rates ranging between 17.5 and 40% [3, 4]. Several important issues regarding the optimal management of patients with severe necrotising pancreatitis have been the subject of continuing debate [3, 4, 5].…”

Section: Introductionmentioning

confidence: 99%

Early and Long-Term Results of Surgery for Severe Necrotising Pancreatitis

et al. 2004

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Background: Necrotising pancreatitis is a challenging problem for the surgeon, as it is associated with considerable morbidity and mortality. The indications, timing of surgical intervention and type of procedure continue to be debated in an effort to improve the outcome of this devastating disease process. Methods: A retrospective analysis of early and long-term results in a series of 44 consecutive patients (34 men, 10 women, median age 46.5, range 13–74 years) who underwent necrosectomy for severe necrotising pancreatitis. In 16 patients necrosectomy and primary abdominal closure with drains was performed, 14 patients had planned staged necrosectomy and delayed abdominal closure with drains, and in 14 patients necrosectomy with open laparostomy was undertaken. Results: There were 8 deaths (18%) and 14 cases (32%) of significant hospital morbidity (fistula 10, pseudocyst 2, renal failure 2). Variables which correlated with mortality were: high APACHE II score, acute renal failure requiring dialysis, and requirement for surgical intervention at an early stage (within the first two weeks). A total of 28 late complications occurred in 21 of the surviving patients (endocrine pancreatic insufficiency 10, exocrine pancreatic insufficiency 2, pseudocyst 2, chronic renal failure 2, incisional hernia 10, recurrent pancreatitis 1, and chronic pain 1). Conclusions: Low mortality can be achieved in patients with severe necrotizing pancreatitis with aggressive surgical intervention and careful perioperative management. Long-term morbidity remains high, and emphasises the need for prolonged follow-up.

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“…Although treatment of necrotizing pancreatitis has improved over recent years, the mortality rates in major centers still may approximate 25% [1]. Necrosis of the pancreas associated with multiorgan failure due to sepsis is the main cause of the high mortality.…”

Section: Introductionmentioning

confidence: 99%

Beta-Cell Function of the Pancreas after Necrotizing Pancreatitis

Buscher¹,

Jacobs²,

Ong³

et al. 1999

Dig Surg

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Aim: To investigate the late sequellae of necrotizing pancreatitis on the endocrine function of the pancreas. Patients and Methods: Twenty patients, 15 men (mean ± SEM age 52.2 ± 2.6 years and BMI 26.8 ± 0.8 kg/m²) and 5 women (age 51.0 ± 7.6 years and BMI 26.7 ± 0.8 kg/m²) were submitted to a glucagon stimulation test 63 (range 8–136) months after an attack of pancreatitis. All nondiabetic patients (n = 15) were also submitted to an oral glucose tolerance test. For comparison, 16 healthy volunteers, 8 men (age 56.0 ± 0.9 years and BMI 26.3 ± 0.4 kg/m²) and 8 women (age 50.5 ± 1.0 years and BMI 28.2 ± 0.6 kg/m²), were also studied. Results: Five patients (25%) had diabetes mellitus and needed insulin treatment, 6 patients (30%) had an impaired glucose tolerance (IGT). Nondiabetic patients (IGT included) had a significantly higher basal insulin level (15.8 ±1.9 vs. 10.9 ± 2.2 mU/l, p < 0.05) and a lower glucose/insulin ratio (p < 0.05) compared with controls. The serum concentrations of insulin and C peptide, after stimulation with glucagon, calculated as peak value, maximal increment and as area under the curve were not significantly different in the nondiabetic patients compared to controls. The subgroup of IGT patients had a significantly higher basal C peptide (p < 0.05) and a reduced maximal increment (p < 0.05). Conclusions: After nonresectional therapy for necrotizing pancreatitis, there is a high prevalence of disturbances in glucose metabolism. Patients with IGT have signs of both loss of β-cell function and insulin resistance.

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Surgical strategies in the treatment of pancreatic necrosis and infection

Cited by 106 publications

References 43 publications

Non-Compliance with National Guidelines in the Management of Acute Pancreatitis in the United Kingdom

Non-Compliance with National Guidelines in the Management of Acute Pancreatitis in the United Kingdom

Early and Long-Term Results of Surgery for Severe Necrotising Pancreatitis

Beta-Cell Function of the Pancreas after Necrotizing Pancreatitis

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