Infected pancreatic necrosis: minimizing the cut

Abstract

The challenge for the pancreatologist managing patients with infected pancreatic necrosis is to devise a treatment algorithm that enables recovery but at the same time limits the morbidity and mortality. The current gold standard remains open necrosectomy. Recent literature contains scattered reports of endoscopic, radiologic, laparoscopic, percutaneous and lumbotomy approaches to managing patients with this condition. This literature review addresses the role of techniques that aim to minimize the physiological insult to the patient with infected pancreatic necrosis.

The Role of Percutaneous Drainage in the Treatment of Severe Acute Pancreatitis on the Basis of the Modified Atlanta Classification

“…Necrosectomy can be performed by using dormia basket. For such treatment more catheters should be placed in the cavity [5,10,11,12,18,21,26,29,33,36,38,43]. Bruennel et al did not find a relation between the thickness, or the number of the drains and the effectiveness.…”

“…Bruennel et al did not find a relation between the thickness, or the number of the drains and the effectiveness. With so-called 'sinus tract endoscopy' necrectomy can be performed effectively following the dilatation of the drain's channel [23,36,43]. Horvath et al performed necrosectomy via the channels of the drains with a supplementary incision using laparoscopy [16,17].…”

“…This differentiation is very important because treatment, especially the minimally invasive one, is different because in cases of WOPN the necrotized tissues should be removed. PNPFC cases can be sterile and infected as well [5,12,18,22,24,33,34,43].…”

“…In those cases where compressive or respiratory complications or pain develop, surgery or less burdensome percutaneous drainage gives an opportunity for treatment, allowing for the descent of the fluid as well as its bacterological examination [3,4,6,8,11,18,24,33,35]. More drains can be placed in cases of multiple pseudocysts [11,18,35] Operation can be avoided in cases treated this way and drainage can lead to complete recovery, in other cases it is suitable for delaying the time of operation [3,4,6,8,11,18,37,43]. In those cases where the cyst cavity communicates with the Wirsung ductal system, external drainage is not effective.…”

“…An alternative method for the treatment of WOPN is the endoscopic transmural necrosectomy and drainage [13,15,27,30,31,41]. Necrosectomy during operation is the suitable method in cases of unsuccessfully treated patients [3,6,10,11,12,22,24,26,28,33,34,36,43].…”