Single-Port Retroperitoneal Pancreatic Necrosectomy for the Treatment of Extrapancreatic Walled-Off Necrotic Collections

Saunders, Rebecca; Neoptolemos, John P.; Hughes, Faye; Ghaneh, Paula; Halloran, Christopher

doi:10.1097/as9.0000000000000019

Cited by 4 publications

(1 citation statement)

References 11 publications

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“…5) require review by a specialist tertiary centre to guide further management, assessing the need to transfer patients for specialist intervention [203]. Management of local complications, such as pancreatic necrosis or fluid collections, or later pseudocysts, should be undertaken in a specialist centre and follow a selective step-up approach, with drainage of necrosis or fluid achieved endoscopically or percutaneously [204][205][206]. These approaches should be considered before attempting minimally invasive or more hazardous open surgery, exceptionally mandated by necrosis of adjacent organs.…”

Section: Management Of Necrosismentioning

confidence: 99%

Acute Pancreatitis: Diagnosis and Treatment

Szatmary

Grammatikopoulos

Cai

et al. 2022

Drugs

237

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Acute pancreatitis is a common indication for hospital admission, increasing in incidence, including in children, pregnancy and the elderly. Moderately severe acute pancreatitis with fluid and/or necrotic collections causes substantial morbidity, and severe disease with persistent organ failure causes significant mortality. The diagnosis requires two of upper abdominal pain, amylase/lipase ≥ 3 ×upper limit of normal, and/or cross-sectional imaging findings. Gallstones and ethanol predominate while hypertriglyceridaemia and drugs are notable among many causes. Serum triglycerides, full blood count, renal and liver function tests, glucose, calcium, transabdominal ultrasound, and chest imaging are indicated, with abdominal crosssectional imaging if there is diagnostic uncertainty. Subsequent imaging is undertaken to detect complications, for example, if C-reactive protein exceeds 150 mg/L, or rarer aetiologies. Pancreatic intracellular calcium overload, mitochondrial impairment, and inflammatory responses are critical in pathogenesis, targeted in current treatment trials, which are crucially important as there is no internationally licenced drug to treat acute pancreatitis and prevent complications. Initial priorities are intravenous fluid resuscitation, analgesia, and enteral nutrition, and when necessary, critical care and organ support, parenteral nutrition, antibiotics, pancreatic exocrine and endocrine replacement therapy; all may have adverse effects. Patients with local complications should be referred to specialist tertiary centres to guide further management, which may include drainage and/or necrosectomy. The impact of acute pancreatitis can be devastating, so prevention or reduction of the risk of recurrence and progression to chronic pancreatitis with an increased risk of pancreas cancer requires proactive management that should be long term for some patients.

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Section: Management Of Necrosismentioning

confidence: 99%

Acute Pancreatitis: Diagnosis and Treatment

Szatmary

Grammatikopoulos

Cai

et al. 2022

Drugs

237

View full text Add to dashboard Cite

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Minimally Invasive Debridement and Lavage of Necrotizing Pancreatitis

Mann

Raraty

2023

The Pancreas

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Cost Analysis and Outcomes of Endoscopic, Minimal Access and Open Pancreatic Necrosectomy

Saunders

Hughes

Evans

et al. 2021

Annals of Surgery Open

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Objectives: To assess both individual patient and institutional costs as well as outcomes in patients with pancreatic necrosis who underwent either endoscopic, minimal access or open pancreatic necrosectomy. These data can be used to evaluate clinical effectiveness with a view to informing local healthcare providers. Background: Intervention for infected pancreatic necrosis is associated with a high morbidity, mortality, and long hospital stays. Minimal access surgical step-up approaches have been the gold standard of care; however, endoscopic approaches are now offered preferentially. Methods: All patients undergoing endoscopic (EN), minimal access retroperitoneal (MARPN), and open (OPN) necrosectomy at a single institution from April 2015 to March 2017 were included. Patients were selected for intervention based on morphology and position of the necrosis and on clinical factors. Patient-level costing systems were used to determine inpatient and outpatient costs. Results: Eighty-six patients were included: 38 underwent EN, 35 MARPN, and 13 OPN. Preoperative APACHEII was 6 versus 9 versus 9 (P = 0.017) and CRP 107 versus 204 versus 278 (P = 0.012), respectively. Postoperative stay was 19 days for EN versus 41 for MARPN versus 42 for OPN (P = 0.007). Complications occurred in 68.4%, 68.6%, and 46.2% (P = 0.298), whereas mortality was 10.5%, 22.9%, and 15.4% (P = 0.379), respectively. Mean total cost was £31,364 for EN, £52,770 for MARPN (P = 0.008), and £60,346 for OPN. Ward and critical care costs for EN were lower than for MARPN (ward: £9430 vs £14,033, P = 0.024; critical care: £5317 vs £16,648, P = 0.056). Conclusions: EN was at least as safe and effective as MARPN and OPN and was associated with markedly reduced hospital stay and cost, although some markers of disease severity were higher in patients undergoing MARPN and OPN. These results support EN as the preferred approach to necrosectomy, but hybrid utilization of all available techniques remains integral to optimal outcomes.

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Single-Port Retroperitoneal Pancreatic Necrosectomy for the Treatment of Extrapancreatic Walled-Off Necrotic Collections

Cited by 4 publications

References 11 publications

Acute Pancreatitis: Diagnosis and Treatment

Acute Pancreatitis: Diagnosis and Treatment

Minimally Invasive Debridement and Lavage of Necrotizing Pancreatitis

Cost Analysis and Outcomes of Endoscopic, Minimal Access and Open Pancreatic Necrosectomy

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