Operative pancreatic debridement: Contemporary outcomes in changing times

Maatman, Thomas K.; Flick, Katelyn F.; Roch, Alexandra M.; Zyromski, Nicholas J.

doi:10.1016/j.pan.2020.05.024

Cited by 16 publications

(10 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Another retrospective study showed that patients who undergo a minimally invasive procedure before surgical debridement are more acutely ill, and when they are "stepped-up" to open pancreatic debridement they experience significantly greater post-operative morbidity. [7] Taken together, these findings suggest that there can be negative consequences to a one-size-fits-all approach to the management of severe AP, with or without necrotizing and/or infected components. Thus, the real-world clinical scenario may be that surgery may be performed late.…”

mentioning

confidence: 84%

“…In this study, patients with NP and a high Acute Physiology and Chronic Health Enquiry II score might have benefitted from surgical intervention, rather than a drainage-first approach. Another retrospective study showed that patients who undergo a minimally invasive procedure before surgical debridement are more acutely ill, and when they are “stepped-up” to open pancreatic debridement they experience significantly greater post-operative morbidity [7] . Taken together, these findings suggest that there can be negative consequences to a one-size-fits-all approach to the management of severe AP, with or without necrotizing and/or infected components.…”

mentioning

confidence: 99%

See 1 more Smart Citation

From “step-up” to “step-jump”: a leap-forward intervention for infected necrotizing pancreatitis

Huang

et al. 2021

Chinese Medical Journal

View full text Add to dashboard Cite

mentioning

confidence: 84%

mentioning

confidence: 99%

From “step-up” to “step-jump”: a leap-forward intervention for infected necrotizing pancreatitis

Huang

et al. 2021

Chinese Medical Journal

View full text Add to dashboard Cite

“…2 However, contemporary studies, incorporating such modern tenets of NP management as delaying intervention and using preoperative drainage, have shown mortality rates in the range of 2% to 10%. 6,21,33 Open transperitoneal necrosectomy can be a valuable technique for multifocal necrosis that responds poorly to less invasive interventions or select cases of intestinal fistula. Transperitoneal necrosectomy can also be performed laparoscopically, although this technique has largely fallen out of favor as the less invasive techniques described above have become available.…”

Section: Transperitoneal Necrosectomymentioning

confidence: 99%

Contemporary Surgical Management of Pancreatic Necrosis

Maurer

Fagenholz

2023

JAMA Surg

View full text Add to dashboard Cite

ImportanceFor decades, infected or symptomatic pancreatic necrosis was managed by open surgical necrosectomy, an approach that has now been largely supplanted by an array of techniques referred to as the step-up approach.ObservationsThis review describes the evidence base behind the step-up approach, when to use the different techniques, and their technical basics. The most common treatment strategies are included: percutaneous drainage, video-assisted retroperitoneal debridement, sinus tract endoscopy, endoscopic transgastric necrosectomy, and surgical transgastric necrosectomy. Also included is the evidence base around management of common complications that can occur during step-up management, such as hemorrhage, intestinal fistula, and thrombosis, in addition to associated issues that can arise during step-up management, such as the need for cholecystectomy and disconnected pancreatic duct syndrome.Conclusions and RelevanceThe treatment strategies highlighted in this review are those most commonly used during step-up management, and this review is designed as a guide to the evidence base underlying these strategies, as surgeons tailor their therapeutic approach to individual patients.

show abstract

“…[21,22] Cases have been reported to emphasize the significance of dynamic surveillance during step-up strategy. [23,24] Recently, several therapeutic strategies including step-jump approach, skip-up approach and even one-step approach have been proposed. [25,26] Cao et al [26] retrospectively analyzed 94 patients (n = 45 in 1-step and n = 49 in step-up groups) and found there was no significance in terms of death (8.89 vs 8.17%; P = .949), long-term complications (18.37 vs 15.56%; P = .717), and new organ failure (14.29 vs 14.33%; P = .832) between 2 groups.…”

Section: Renovation Of Step-up Approachmentioning

confidence: 99%

Acute necrotizing pancreatitis: challenges and interventions—a narrative review

Luo

Kong

et al. 2022

Journal of Pancreatology

View full text Add to dashboard Cite

Acute pancreatitis (AP) is a complicated disease with rising incidence over the years. Twenty percent of AP will develop into acute necrotizing pancreatitis (ANP). Interventions for ANP have evolved from traditional open surgery to minimally invasive step-up approaches. Infected pancreatic necrosis (IPN) is the most serious event of ANP and associated with extremely poor prognosis. The contrast-enhanced computed tomography(CECT)-based classification of IPN describes various types of IPN and will help to carry out surgical interventions for each subtype. Nevertheless, many challenges are still remaining during the treatment of ANP. Including the balance between endoscopic and surgical approaches, and the selection of optimal timing of surgical intervention for infected necrosis. In nowadays treatment scenario of ANP, the necessity for open surgery remains to be debated. Despite of the development of advanced interventional techniques, postoperative residual infection (PRI) remains thorny, and effective prevention and treatment of PRI is of significance.

show abstract

Operative pancreatic debridement: Contemporary outcomes in changing times

Cited by 16 publications

References 32 publications

From “step-up” to “step-jump”: a leap-forward intervention for infected necrotizing pancreatitis

From “step-up” to “step-jump”: a leap-forward intervention for infected necrotizing pancreatitis

Contemporary Surgical Management of Pancreatic Necrosis

Acute necrotizing pancreatitis: challenges and interventions—a narrative review

Contact Info

Product

Resources

About