Open Pancreatic Necrosectomy Is Still Safe and Effective Treatment for Pancreatic Necrosis Managed by Step-Up Approach (original) (raw)
Pancreatic Necrosectomy: Definitions and Technique
Journal of Gastrointestinal Surgery, 2005
Pancreatic necrosis implies a permanent condition in which a portion of the pancreas loses its blood supply. This condition is irreversible, yet many cases of "necrosis" will, after recovery, culminate in a patient with a normal pancreas by computed tomography or endoscopic retrograde cholangiopancreatography. The problem is in our definitions. An understanding of this disease through its related definitions is required before judgment deems "necrosectomy to be appropriate." These definitions are of pancreatic ductal disruption, peripancreatic fluid collections, pseudocyst, pancreatic abscess, and pancreatic necrosis. The technique of necrosectomy removes mature "necrosum" and is described in this article. Once necrosectomy is completed, the surgeon still depends on the continued support of interventional radiology through regular exchange of large-bore pancreatic drains. In our institution, many of these drain sites are placed at some time before necrosectomy. Once the team method has been implemented, the following improved outcomes will result-lowered need for necrosectomy and single digit mortality. (J GASTROINTEST SURG 2005;9:436-439) Ć 2005 The Society for Surgery of the Alimentary Tract Before describing the technique of pancreatic necrosectomy, a list of definitions is discussed. Pancreatic necrosis implies a permanent condition in which a portion of the pancreas loses its blood supply. It is irreversible, yet many cases of "necrosis" will, after recovery, culminate in a patient with a normal pancreas on computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP). The problem is in our definitions. Depending on the extent of necrosis, mild to severe complications of necrosis ensue. Almost every case of severe pancreas inflammation is associated with a pancreatic duct disruption with or without necrosis. Unclear is which of the events occurred first-necrosis or ductal disruption. We believe that almost every case of severe pancreatitis is made worse by a "plumbing" problem in the form of a leak. Our studies have shown us that the presence of a ductal disruption is significantly associated with the presence of necrosis, mortality, and the length of hospital stay. 1 Pancreatic necrosis and pancreatic ductal disruptions are integrally entwined. Taken further, the amount of pancreatic necrosis directly affects the outcomes of From the Departments of General Surgery (L.W.T.
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 2013
The purpose of this meta-analysis and systematic review is to compare minimally invasive necrosectomy (MIN) versus open necrosectomy (ON) surgery for infected necrosis of acute pancreatitis. Methods: One randomized controlled trial and 3 clinical controlled trials were selected, with a total of 336 patients (215 patients who underwent MIN and 121 patients underwent ON) included after searching in the following databases: