Severe Acute Pancreatitis - How Conservative Can We Be?

Alberts, Christian; Alsfasser, Guido

doi:10.1159/000494097

Cited by 9 publications

(6 citation statements)

References 37 publications

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“…2 Conservative management alone is a reasonable option for the treatment of pancreatic necrosis; however, infection of pancreatic necrosis usually dictates more aggressive management. 3,4 The treatment approach consists of upfront surgical necrosectomy, percutaneous catheter drainage alone or followed by necrosectomy, and endoscopic necrosectomy. 5 Endoscopic modalities for treatment have demonstrated propitious outcomes.…”

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confidence: 99%

Outcomes of Endoscopic and Surgical Pancreatic Necrosectomy: A Single Institution Experience

Martı́nez

Cole

Dove

et al. 2019

The American Surgeon™

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Pancreatic necrosis can be managed conservatively; however, infection of pancreatic necrosis usually dictates more aggressive management. Our study aimed to assess the outcomes of open pancreatic necrosectomy (OPN) and endoscopic pancreatic necrosectomy (EPN) in a single center. Data from patients undergoing pancreatic necrosectomy at the Geisinger Medical Center from January 1, 2007, to April 25, 2016, were collected and retrospectively analyzed. Cohorts were composed of EPN (n = 22) and OPN (n = 34) groups. The prevalence of preoperative respiratory failure, septic shock, and multiorgan dysfunction syndrome was higher in the OPN group. The OPN group presented with a higher Bedside Index Severity in Acute Pancreatitis score. Postoperative abscess, persistent kidney dysfunction, and death were more frequent in the OPN group. The EPN group had a higher read-mission rate. The results of the univariate analysis for complication and mortality demonstrated that higher mortality and persistent kidney dysfunction were associated with the procedure type, specifically OPN and with a higher Bedside Index Severity in Acute Pancreatitis score. Patients who presented with higher severity of disease underwent an OPN, whereas EPN often was performed successfully in a more benign clinical setting. However, patients with infected necrosis are served best in a tertiary medical facility where multiple treatment modalities are available.

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confidence: 99%

Outcomes of Endoscopic and Surgical Pancreatic Necrosectomy: A Single Institution Experience

Martı́nez

Cole

Dove

et al. 2019

The American Surgeon™

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“…Any intervention should only be performed after an initial stabilization period of about 3 weeks. The only exception should be limited to acute life-threatening conditions like bowel ischemia, abdominal compartment syndrome, or perforations 4 , 12 – 14 .…”

Section: Introductionmentioning

confidence: 99%

Conservative therapy of severe acute pancreatitis is a safe option – results of a 15-year long-term follow-up cohort study

Alsfasser,

Klar,

Feitl

et al. 2023

Annals of Medicine &Amp; Surgery

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Background: Treatment of severe acute pancreatitis can be challenging with high mortality. In 2012 we reported a significantly reduced in-hospital mortality if these patients are treated conservatively for at least the first 3 weeks in the course of the disease as compared to early necrosectomy. We performed a long-term follow-up and compared the outcome of these two study groups (group 1 – early necrosectomy, n=20 versus group 2 – primary conservative treatment, n=24). Materials and methods: Follow-up of the study patients by personal contact, phone survey, or data from primary care physician. Median follow-up was 15 years (range 10–22 years). This trial is registered at: Research Registry UIN researchregistry8697. Results: Eleven survivors of group 1 and 22 survivors of group 2 were discharged after initial treatment. Ten of 11 surviving patients of group 1 (90.9%) and 20 of 22 surviving patients of group 2 (90.9%) were included in this study. Between groups, there were no statistical differences in the rate of resubmission (P=0.23), development of diabetes (P=0.78), or development of exocrine insufficiency (P=1.0). However, long-term survival in group 2 was significantly better than that of group 1 (P=0.049). Conclusion: Primary conservative treatment of severe acute pancreatitis without early necrosectomy does not lead to early complications and even shows an advantage in long-term survival. Therefore conservative treatment of severe acute pancreatitis is safe and there is no absolute need for necrosectomy in severe acute pancreatitis.

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“…A fourth class of severity, critical AP, is described in the determinantbased classification [10,12] when both infected necrosis and persistent organ failure are present together. The disease is potentially life threatening with mortality rate of about 10-30% for severe cases [7,[13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Patients with Exploratory Laparotomy for Acute Abdomen with Intraoperative Finding of Acute Pancreatitis

Abed¹,

Kareem²,

Ibrahim³

2022

DJM

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Background: Acute pancreatitis (AP) is one of the main causes of acute abdomen that requires hospitalization and multidisciplinary management. The spectrum of the disease is wide with variable presentations that mimic the clinical features of other acute illnesses. Occasionally the diagnosis of AP is only made atlaparotomy, especially when there is doubt in the preoperative diagnosis. Objective: To evaluate the findings during exploratory laparotomy for patients with acute abdomen and were diagnosed as cases of AP intraoperatively, and to determine the postoperative outcome during the follow up period for these patients. Patients and Methods: A retospective study performed at the Department of General Surgery- Baquba Teaching Hospital- Diyala- Iraq, from January 2011 to December 2020. Thirty-three patients (16 male and 17 female) were included, all patients had history of acute abdomen with unknown cause preoperatively, in spite of doing the available preoperative investigations, and were found to have acute pancreatitis intraoperatively. A standardized data collection form was completed and analyzed for each patient. Results: The patients' ages ranged from 8 to 75 years with a mean age of 40.2 years. The majority of the patients were found to have pancreatic oedema (66.67%), followed by hemorrahgic pancreatitis (15.15%), pancreatic necrosis (12.12%) and pancreatic tumours that presented as acute pancreatitis (6.06%). During the follow up period 13 patients (39.39%) recovered with no complications while 20 patients (60.6%) developed one or more complication mainly surgical site infections in 18.18% of patients, pancreatic pseudocyst (15.15%), death (15.15%), ascites (9.1%), chronic pancreatitis (6.1%), pleural effusion (6.1%), while ileus, ARDS, DIC and acute renal failure occurred in (3%) for each. Conclusion: AP is an important cause of acute abdomen that is associated with severe mortality and morbidity and a high index of suspicion is needed to avoid the frequent misdiagnosis. Despite of rapid advances in the diagnostic strategy, still exploratory laparotomy is indicated in some cases to reach a sound diagnosis although such intervention is undesirable and might increase the postoperative morbidity and mortality. Keywords: acute abdomen, acute pancreatitis, explorative laparotomy, postoperative complications.

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Severe Acute Pancreatitis - How Conservative Can We Be?

Cited by 9 publications

References 37 publications

Outcomes of Endoscopic and Surgical Pancreatic Necrosectomy: A Single Institution Experience

Outcomes of Endoscopic and Surgical Pancreatic Necrosectomy: A Single Institution Experience

Conservative therapy of severe acute pancreatitis is a safe option – results of a 15-year long-term follow-up cohort study

Evaluation of Patients with Exploratory Laparotomy for Acute Abdomen with Intraoperative Finding of Acute Pancreatitis

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