Laparoscopic assisted percutaneous drainage of infected pancreatic necrosis

Horvath, Karen D.; Kao, Lillian S.; Ali, Amjad; Wherry, Kimberly L.; Pellegrini, Carlos A.; Sinanan, Mika

doi:10.1007/s004640080010

Cited by 98 publications

(87 citation statements)

References 17 publications

(24 reference statements)

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“…The suggestion that the retroperitoneal approach is associated with increased complication rates [1][2][3] was not confirmed by our results. The incidence of complications following the retroperitoneal approach did not differ from that in the laparotomy/ CPL group and was similar to those previously reported after laparotomy [10,12,24,25,28].…”

Section: Discussioncontrasting

confidence: 56%

“…This technique aims at minimizing surgical stress in an already critically ill patient, thereby potentially reducing morbidity and mortality. Since then, several relatively small series (median 15 patients, range 5-46 patients) on similar ''minimally invasive'' retroperitoneal approaches have been published and have shown promising results [2][3][4][5][6][7]. Consequently, these techniques are now the preferred method of intervention in several expert centers.…”

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confidence: 99%

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Case‐Matched Comparison of the Retroperitoneal Approach With Laparotomy for Necrotizing Pancreatitis

et al. 2007

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Background Minimally invasive necrosectomy through a retroperitoneal approach is gaining popularity for the treatment of necrotizing pancreatitis. There is, however, no substantial evidence from comparative studies in favor of this technique over laparotomy. The aim of this case‐matched study was to perform the first head‐to‐head comparison of necrosectomy by the retroperitoneal approach with laparotomy in patients with necrotizing pancreatitis. Methods Between 2001 and 2005, there were 15 of 841 consecutive acute pancreatitis patients who underwent necrosectomy by the retroperitoneal approach using a small flank incision. These patients were matched for the presence of preoperative organ failure, status of infection, timing of surgery, age, and computed tomography severity index score with 15 of 46 patients treated with necrosectomy by laparotomy and continuous postoperative lavage (CPL). Methods In addition to all matched preoperative characteristics, there were no significant differences in sex, preoperative intensive care unit (ICU) admission, preoperative ICU stay, preoperative APACHE‐II scores, and preoperative multiple organ failure (MOF). Postoperative complications requiring reintervention occurred in six patients in each group (p = 1.000). Postoperative new‐onset MOF occurred in 10 patients in the laparotomy/CPL group versus 2 patients in the retroperitoneal approach group (p = 0.008). Six patients died in the laparotomy/CPL group versus 1 patient in the retroperitoneal approach group (p = 0.080). Conclusions The less postoperative organ failure and the trend toward lower mortality may point to a benefit of the retroperitoneal approach over laparotomy. A randomized controlled design is, however, still required to answer definitively the question of which operative technique is preferably for patients with (infected) necrotizing pancreatitis.

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Section: Discussioncontrasting

confidence: 56%

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confidence: 99%

Case‐Matched Comparison of the Retroperitoneal Approach With Laparotomy for Necrotizing Pancreatitis

et al. 2007

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“…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]. More than 20% of the patients treated with the minimal invasive method recovered without operation.…”

Section: Wwwintechopencommentioning

confidence: 99%

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

Szentkereszty¹,

Kotán²,

Sápy³

2012

Acute Pancreatitis

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What to drain? Acute peripancreatic fluid collection (APFC)According to the Atlanta Classification peripancreatic fluid collection develops in the early phase of acute pancreatitis in about 40% of cases. The acute fluid collection usually develops around the pancreas but sometimes emerges in the glandular area and does not contain a high quantity of necrosis. Not rarely, it spreads into the chest, mediastinum and/or into the pararenal area. Several fluid collections can develop at the same time and can shuttle together. The rich pancreatic enzyme content of the fluid can indicate communication with the pancreatic duct or indicate parenchymal necrosis. They do not have definite walls, and are limited by the walls of the surrounding organs. In a significant number of cases (about 30-50%), spontaneous resolution occurs without surgical or other intervention. If they do not show tendency towards resolution, they can become of significant size and cause clinical symptoms or complications [5,6,33,44]. The most frequent complaints caused by a big, 8-15 cm size acute fluid collection are pain, tension, and increasing abdominal pressure which can significantly worsen the efficiency of breathing [1,9]. In other cases they can cause compression symptoms (jaundice, duodenal obstruction) or bleeding can develop inside of them. Another frequent complication is the

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“…Thus, methods of percutaneous drainage guided by ultrasound or by CT have been used with satisfactory resolution rates and in a few days after surgery 9,19,23,31,34,60 .…”

Section: Collections and Pancreatic Abscessmentioning

confidence: 99%

Quando e como tratar as complicações na necrose pancreática infectada

Silva¹,

Pacheco-Junior²,

Moricz³

et al. 2010

ABCD, arq. bras. cir. dig.

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-Introduction -Acute pancreatitis is presented in its severe form between 10% and 15% of cases and is associated with high mortality. In the initial phase, evolution characterized by the onset of organ dysfunction and subsequently by the presence of pancreatic necrosis and its complications. Methods -It was performed a literature review with consultations in the following databases: PubMed, SciELO, Lilacs. Headings used were the following: acute pancreatitis, infection, pancreatic necrosis. Conclusion -The treatment of pancreatic necrosis, despite the advent of modern methods and techniques, is still challenging. Because of the multiplicity of aspects that may take the examination of each case, in view of the extent, severity and location of facilities within a patient's care, the treatment should be individualized for each case.RESUMO -Introdução -A pancreatite aguda se apresenta na sua forma grave entre 10% e 15% dos casos e está associada com alta mortalidade. Na fase inicial da evolução caracteriza-se pelo aparecimento de disfunções orgânicas e posteriormente pela presença de necrose pancreática e suas complicações. Método -Foi realizada revisão da literatura com consultas feitas nas seguintes bases de dados: Pubmed, Scielo, Lilacs. Os descritores cruzados foram os seguintes: pancreatite aguda, infecção, necrose pancreática. Conclusão -O tratamento da necrose pancreática, apesar do advento de modernos métodos e técnicas, ainda continua desafiador. Devido à multiplicidade de aspectos que pode assumir, a análise de cada caso, tendo em vista a extensão, gravidade e meios existentes no local de atendimento do paciente, é que deverá orientar o tratamento possível, sendo ele sempre individualizado a cada caso.

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Laparoscopic assisted percutaneous drainage of infected pancreatic necrosis

Abstract: This early, limited experience has demonstrated the feasibility of laparoscopic assisted percutaneous drainage for infected pancreatic necrosis. With this technique, two-thirds of our patients avoided the morbidity of a laparotomy.

Cited by 98 publications

References 17 publications

Case‐Matched Comparison of the Retroperitoneal Approach With Laparotomy for Necrotizing Pancreatitis

Case‐Matched Comparison of the Retroperitoneal Approach With Laparotomy for Necrotizing Pancreatitis

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

Quando e como tratar as complicações na necrose pancreática infectada

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