Timing of surgical intervention in patients of infected necrotizing pancreatitis not responding to percutaneous catheter drainage

Shenvi, Sunil D.; Gupta, Rajesh; Kang, Mandeep; Khullar, Madhu; Rana, Surinder Singh; Singh, Rajinder; Bhasin, Deepak K.

doi:10.1016/j.pan.2016.08.006

Cited by 25 publications

(17 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A step-up approach with intention to avoid surgery led to a success rate of 68.5%. Study suggests that a higher percentage of patients can be successfully managed without surgery by an experienced team trained in this approach 10 .…”

Section: Discussionmentioning

confidence: 99%

Necrotizing Pancreatitis: Description of Videoscopic Assisted Retroperitoneal Debridement (Vard) Technique With Covered Metallic Stent

Houghton

Vázquez

Zeledón

et al. 2018

ABCD, arq. bras. cir. dig.

View full text Add to dashboard Cite

Background : Acute pancreatitis is the third most common gastrointestinal disorder requiring hospitalization in the United States, with annual costs exceeding $2 billions. Severe necrotizing pancreatitis is a life-threatening complication developed in approximately 20% of patients. Its mortality rate range from 15% in patients with sterile necrosis to up 30% in case of infected one associated with multi-organ failure. Less invasive treatment techniques are increasingly being used. These techniques can be performed in a so-called step-up approach. Aim: To present the technique for videoscopic assisted retroperitoneal debridement (Vard technique) with covered metallic stent in necrotizing pancreatitis. Method: A guide wire was inserted through the previous catheter that was removed in the next step. Afterwards, the tract was dilated over the guide wire. Then, a partially covered metallic stent was deployed. A 30 degrees laparoscopic camera was inserted and the necrosis removed with forceps through the expanded stent under direct vision. Finally, the stent was removed and a new catheter left in place. Result : This technique was used in a 31-year-old man with acute pain in the upper abdomen and diagnosed as acute biliary pancreatitis with infected necrosis. He was treated with percutaneous drains at weeks 3, 6 and 8. Due to partial recovery, a left lateral VARD was performed (incomplete by fixed and adherent tissue) at 8th week. As the patient´s inflammatory response was reactivated, a second VARD attempt was performed in three weeks later. Afterwards, patient showed complete clinical and imaging resolution. Conclusions : Videoassisted retroperitoneal necrosectomy using partially covered metallic stent is a feasible technique for necrotizing pancreatitis.

show abstract

Section: Discussionmentioning

confidence: 99%

Necrotizing Pancreatitis: Description of Videoscopic Assisted Retroperitoneal Debridement (Vard) Technique With Covered Metallic Stent

Houghton

Vázquez

Zeledón

et al. 2018

ABCD, arq. bras. cir. dig.

View full text Add to dashboard Cite

show abstract

“…The overall complication rate was 20%, and the most common complications were the formation of pancreaticocutaneous and pancreaticoenteric fistula . Similarly, a systematic review evaluating the role of conservative treatment (including antibiotic + PCD) in infected pancreatic necrosis patients demonstrated successful outcomes in 64% of patients …”

Section: Percutaneous Catheter Drainagementioning

confidence: 98%

“…Endoscopic necrosectomy-summary of major studies were the formation of pancreaticocutaneous and pancreaticoenteric fistula 55. Similarly, a systematic review evaluating the role of conservative treatment (including antibiotic + PCD) in infected pancreatic necrosis patients demonstrated successful outcomes in 64% of patients 56. The mortality and morbidity rates were 15.3 and 63.5%, respectively, in the MARPNs group and 23.3 and 81.7%, respectively, in the open necrosectomy group.…”

mentioning

confidence: 94%

Endotherapy for pancreatic necrosis: An update

et al. 2018

View full text Add to dashboard Cite

Approximately 20% of patients with acute pancreatitis develop pancreatic necrosis. The presence of necrosis in a pancreatic collection significantly worsens the prognosis. Pancreatic necrosis is associated with high mortality and morbidity. In the last few decades, there has been a significant revolution in the treatment of infected pancreatic necrosis. A step‐up approach has been proposed, from less invasive procedures to the operative intervention. Minimally invasive treatment modalities such as endoscopic drainage and necrosectomy, percutaneous drainage, and minimally invasive surgery have recently replaced open surgical necrosectomy as the first‐line treatment option. Endoscopic intervention for pancreatic necrosis is being increasingly performed with good success and a lower complication rate. However, techniques of endotherapy are still not uniform and vary as per local expertise, and there are still many unresolved questions with regard to the interventions in patients with pancreatic necrosis. The objective of this paper is to critically review the literature and update the concepts of endoscopic interventional therapy of pancreatic necrosis.

show abstract

“…In a systematic review including 10 retrospective series and one RCT with 384 patients who underwent percutaneous drainage because of acute necrotizing pancreatitis, percutaneous drainage was sufficient as definitive treatment in 56% of patients [54]. Another analysis showed that percutaneous drainage along with antibiotics was successful treatment in 50% of patients [55]. There are no comparative trials yet regarding catheter diameter, but large-bore catheters seem to less frequently obstruct by the necrotic debris.…”

Section: Management Of Acute Necrotic Collections and Walled-off Necrmentioning

confidence: 99%

Management of (Peri)Pancreatic Collections in Acute Pancreatitis

et al. 2019

View full text Add to dashboard Cite

The development of (peri)pancreatic fluid collections are frequent local complications in acute pancreatitis. These collections are classified as early (acute peripancreatic fluid collection or acute necrotic collection) or late (walled-off necrosis or pseudocyst). The majority of pancreatic fluid collections resolve spontaneously and do not require intervention. However, infection may require intervention. Interventions may include endoscopic or percutaneous catheter drainage, or in a next step endoscopic or surgical necrosectomy, minimally invasive or open. The best timing for the first intervention is still under investigation. Whereas some use antibiotics to postpone intervention until the stage of walled-off necrosis, others drain earlier. Endoscopic drainage of (peri)pancreatic fluid collections is now the preferred approach of drainage due to reduced morbidity as compared to surgical or percutaneous drainage. However, each collection must be treated according to a tailored approach. The final treatment should take into consideration anatomic characteristics, patient preference, comorbidity profile of the patient, and physician discretion. This review summarizes the current evidence on the treatment of (peri)pancreatic fluid collections.

show abstract

Timing of surgical intervention in patients of infected necrotizing pancreatitis not responding to percutaneous catheter drainage

Cited by 25 publications

References 9 publications

Necrotizing Pancreatitis: Description of Videoscopic Assisted Retroperitoneal Debridement (Vard) Technique With Covered Metallic Stent

Necrotizing Pancreatitis: Description of Videoscopic Assisted Retroperitoneal Debridement (Vard) Technique With Covered Metallic Stent

Endotherapy for pancreatic necrosis: An update

Management of (Peri)Pancreatic Collections in Acute Pancreatitis

Contact Info

Product

Resources

About