Management of Infected Pancreatic Necrosis—The “Step Up” Approach and Minimal Access Retroperitoneal Pancreatic Necrosectomy

John, Biku Joseph; Swaminathan, Sethuraman; Venkatakrishnan, L; Singh, Gursharan; Krishnaveni, G.; Mohandas, Naveen; Pandey, Shashiprakash; Devanand, B

doi:10.1007/s12262-014-1197-0

Cited by 5 publications

(4 citation statements)

References 7 publications

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“…In the present study, patients had a significantly decreased APACHE II score, incidence of organ failure, CT severity index and CRP level after undergoing percutaneous catheter drainage, in accordance with previous reports. John and colleagues first reported a patient with infected necrotizing pancreatitis managed with a step‐up approach using the MARPN technique.…”

Section: Discussionsupporting

confidence: 91%

Minimal-access retroperitoneal pancreatic necrosectomy for infected necrotizing pancreatitis: a multicentre study of a step-up approach

Liu¹,

Yang

Wang³

et al. 2020

British Journal of Surgery

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Background Various minimally invasive approaches have been described for infected necrotizing pancreatitis. This article describes a modified minimal‐access retroperitoneal pancreatic necrosectomy (MARPN) procedure assisted by gas insufflation. Methods This retrospective, observational study documented patients who had undergone a step‐up MARPN between 1 January 2010 and 31 December 2016. A minimum follow‐up of 1 year was required for inclusion. The step‐up approach involved percutaneous catheter drainage followed by the modified MARPN and necrosectomy. If more than one access site was needed it was categorized as complex MARPN. Results Of 212 patients with infected necrotizing pancreatitis, 164 (77·4 per cent) underwent a step‐up approach. The median number of percutaneous catheter drains and MARPN procedures was 3 (range 1–7) and 1 (1–6) respectively. Ninety patients (54·9 per cent) underwent complex MARPN. For residual necrosis after MARPN, three patients (1·8 per cent) underwent sinus tract gastroscopy, and 11 (6·7 per cent) had sinography combined with a tube change. However, operations in 13 patients (7·9 per cent) required conversion to open surgery. Postoperative complications developed in 103 patients (62·8 per cent). The mortality rate was 6·1 per cent (10 deaths). Conclusion A step‐up approach using a modified MARPN for infected necrotizing pancreatitis is a reasonable option.

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Section: Discussionsupporting

confidence: 91%

Minimal-access retroperitoneal pancreatic necrosectomy for infected necrotizing pancreatitis: a multicentre study of a step-up approach

Liu¹,

Yang

Wang³

et al. 2020

British Journal of Surgery

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“…However, this approach was associated with high morbidity and mortality rates. As a result, less invasive techniques have been explored, leading to the development of the step-up approach, which entails a sequential treatment algorithm that starts with conservative measures and gradually progresses to more invasive interventions if necessary [49]. The treatment begins with initial medical management, including fluid resuscitation, pain control, and broad-spectrum antibiotics, to stabilize the patient and control systemic complications.…”

Section: Infected Pancreatitis and Antibiotic Therapymentioning

confidence: 99%

Antibiotic Utilization in Acute Pancreatitis: A Narrative Review

et al. 2023

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Acute pancreatitis is a complex inflammatory disease with significant morbidity and mortality. Despite advances in its management, the role of antibiotics in the prophylaxis and treatment of acute pancreatitis remains controversial. The aim of this comprehensive review is to analyze current evidence on the use of antibiotics in acute pancreatitis, focusing on prophylactic and therapeutic strategies. Prophylactic use aims to prevent local and systemic infections. However, recent studies have questioned the routine use of antibiotics for prophylaxis and highlighted the potential risks of antibiotic resistance and adverse effects. In selected high-risk cases, such as infected necrotizing pancreatitis, prophylactic antibiotic therapy may still be beneficial. As for therapeutic use, antibiotics are usually used to treat infected pancreatic necrosis and extrapancreatic infections. When selecting an antibiotic, the microbiologic profile and local resistance patterns should be considered. Combination therapy with broad-spectrum antibiotics is often recommended to cover both Gram-positive and Gram-negative pathogens. Recent research has highlighted the importance of individualized approaches to antibiotic use in acute pancreatitis and underscored the need for a tailored approach based on patient-specific factors. This review also highlights the potential role of new antimicrobial agents and alternative strategies, such as probiotics, in the management of acute pancreatitis.

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“…Lo observado en el comportamiento de la procalcitonina es prometedor. Recientemente, estudios en Reino Unido, como el PROCAP, tratan de establecer una relación entre la PCT y el inicio de antibioticoterapia en la pancreatitis (7,(17)(18)(19)(20)(21)(22)(23)(24)(25)(42)(43)(44)(45) . Si bien ningún estudio revela adecuadamente una capacidad de predicción de la procalcitonina en esta patología (5,7,8,16,(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) , en nuestro estudio podemos evidenciar una tendencia de este marcador como predictor de mortalidad, sin embargo, más estudios prospectivos se necesitan para confirmar esta hipótesis.…”

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Manejo quirúrgico de la necrosis pancreática infectada. Serie de casos en un hospital de cuarto nivel en Bogotá, Colombia, 2014-2021

Rey¹,

Ricaurte²,

Gómez

et al. 2022

Rev. colomb. Gastroenterol.

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Introducción: la pancreatitis es una patología frecuente en nuestro medio, mayormente relacionada con la patología biliar benigna. Esta puede progresar a formas severas en 10 %-15 % de los casos, en donde el tejido pancreático se necrosa y forma grandes colecciones, con riesgo de infección. En Colombia no conocemos los datos epidemiológicos acerca de la incidencia de este tipo de complicaciones, ni del manejo de las mismas. Objetivo: este estudio tiene como objetivo estudiar la prevalencia de la necrosis pancreática infectada y describir los casos identificados en un hospital de alto nivel de complejidad entre 2014 y 2021. Métodos: estudio observacional de corte transversal. Se analizaron los registros de pacientes diagnosticados con pancreatitis en segunda etapa. Se estudiaron aquellos casos que presentaron necrosis pancreática infectada y se sometieron a desbridamiento más drenaje quirúrgico por vía laparoscópica y abierta en el Hospital Universitario Mayor Méderi de Bogotá, Colombia, entre enero de 2014 y enero de 2021. Se realizó un muestreo por conveniencia, sin cálculo de tamaño de muestra. Se recolectaron variables demográficas y clínicas de los pacientes. Se realizó un análisis estadístico descriptivo de las variables obtenidas en Excel. Las variables cualitativas se describieron a través de frecuencias absolutas y relativas; mientras que las cuantitativas se expresaron mediante medidas de tendencia central y de dispersión en función de su distribución. Resultados: se analizaron 1020 episodios de pancreatitis y se evidenció necrosis pancreática en 30 pacientes, es decir, una prevalencia de período de 2,9 %. De los pacientes, 83 % (n = 25) se llevó a drenajes por vía abierta, con un 48 % (n = 12) de mortalidad. En relación con el manejo por vía laparoscópica, la reducción en la falla orgánica posoperatoria fue de 40 % (n = 2), con un 30 % menos de duración en la estancia hospitalaria, comparado con la vía abierta. Aquellos pacientes que presentaron un nivel de procalcitonina (PCT) menor de 1,8 ng/mL tuvieron menos mortalidad. Conclusiones: el abordaje laparoscópico muestra resultados prometedores en cuanto a la morbilidad y mortalidad final observada.

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Management of Infected Pancreatic Necrosis—The “Step Up” Approach and Minimal Access Retroperitoneal Pancreatic Necrosectomy

Cited by 5 publications

References 7 publications

Minimal-access retroperitoneal pancreatic necrosectomy for infected necrotizing pancreatitis: a multicentre study of a step-up approach

Minimal-access retroperitoneal pancreatic necrosectomy for infected necrotizing pancreatitis: a multicentre study of a step-up approach

Antibiotic Utilization in Acute Pancreatitis: A Narrative Review

Manejo quirúrgico de la necrosis pancreática infectada. Serie de casos en un hospital de cuarto nivel en Bogotá, Colombia, 2014-2021

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