Objectives Because infected pancreatic necrosis (IPN) has multiple presentations, not all patients are likely to benefit from the same first-line treatment. Our objective was to evaluate morbidity and mortality in a series of patients treated with a multimodal therapeutic approach. Methods Between May 2012 and May 2019, 51 patients diagnosed with IPN were treated. The 5 initial treatment alternatives were as follows: percutaneous drainage, minimally invasive necrosectomy, antibiotics alone, transgastric necrosectomy, and temporizing percutaneous/endoscopic drainage. Initial treatment selection depended on evolution, clinical condition, and extension of pancreatic necrosis. Success, morbidity, and mortality rates were determined. Results In terms of determinant-based classification, 37 were classified as severe, and 14 as critical. Percutaneous, temporizing drainage, minimally invasive necrosectomy, antibiotics alone and transgastric necrosectomy approaches were used in 21, 10, 11, 4, and 5 patients, respectively. Necrosectomy was not required in 18 patients (35%). There were no significant differences in mortality among the different treatment approaches (P < 0.45). Overall success, morbidity, and mortality rates were 68.6%, 52.9%, and 7.8%, respectively. Conclusions The multimodal approach seems to be a rational and efficient strategy for the initial treatment of IPN.

La contemporización biliar percutánea como estrategia en el tratamiento de la lesión quirúrgica de la vía biliar Percutaneous biliary intervention as an initial treatment for injury of the bile ductAntecedentes: El drenaje biliar percutáneo (DBP) se ha utilizado para tratar lesiones quirúrgicas de la vía biliar y como complemento de la cirugía de reparación. Objetivo: Presentar los resultados del drenaje biliar percutáneo en una serie consecutiva de pacientes con lesiones quirúrgicas o secuelas de reparaciones quirúrgicas de la vía biliar. Material y Métodos: Se analizaron los pacientes tratados inicialmente mediante DBP. Se utilizó la clasificación de Strasberg y se registró: tipo de operación, vía de abordaje, número de reintervenciones, intentos de reparación biliar y presentación clínica. En los pacientes con continuidad bilioentérica, la primera opción fue el tratamiento percutáneo. Se evaluó el DBP en el pre, intra y postoperatorio y pre dilatación percutánea Resultados: En el hospital Argerich, período 2000 a 2014, se incluyeron 76 enfermos, 68.4% mujeres y post colecistectomía 97%. El 77,6% fueron lesiones Tipo E2 a E5. El porcentaje de enfermos con control de síntomas pre cirugía o dilatación percutánea fue: ictericia 59%, colestasis 5%, colangitis 91%, fístula biliar 87%, prurito 90%, retiro del hepaticostoma o Kehr 91%. En 13 de 16 pacientes con fístula biliar externa se internalizó el catéter biliar a la cavidad abdominal. En el 70% de 52 pacientes operados, el catéter facilitó la identificación de la vía biliar proximal. En el postoperatorio, no hubo fístulas biliares de la anastomosis bilioentérica, y se detectaron 3 pacientes con estenosis biliar residual y 2 con segmentos biliares aislados que fueron tratados. Conclusión: El DBP resulta útil en el preoperatorio, intraoperatorio y postoperatorio de los pacientes con lesiones quirúrgicas biliares RESUMEN ABSTRACTBackground: Percutaneous biliary drainage (PTBD) has been used to treat surgical bile duct injuries and as an adjunct to repair surgery. Objective: To present the results of PTDB in a consecutive series of patients with surgical injuries or sequelae of surgical repairs of the bile duct. Material and methods: Patients initially treated with PTBD were analyzed. Strasberg classification was used and recorded: type of operation, surgical approach, number of reoperations, biliary repair attempts and clinical presentation. In patients with bilioenteric continuity, percutaneous biliary treatment was the first option. PTBD was evaluated in the pre, intra and postoperative period and in the pre dilatation period. Results: At the Hospital Argerich, from 2000 to 2014, 76 patients were included, 68.4% women and 97% post cholecystectomy. The lesions were Type E2 to E5 in 77% of cases. The percentage of patients with controlled symptoms before surgery or percutaneous dilatation was: jaundice 59%, cholestasis 5%, cholangitis 91%, biliary fistula 87%, pruritus 90%, withdrawal hepaticostoma or T-Kehr 91%. In 13 of 16 patients with external biliary fistula,...