Surgical Versus Nonsurgical Treatment of Infected Pancreatic Necrosis: More Arguments to Change the Paradigm

Pascual, Isabel; Sabater, Luís; Añón, R; Calvete, Julio; Pacheco, Gema Ramírez; Muñoz, Elena; Lizarraga, Javier; Sastre, Juan; Peña, Andrés; Mora, Francisco; Pérez-Griera, Jaime; Ortega, Joaquı́n; Benages, A

doi:10.1007/s11605-013-2266-6

Cited by 21 publications

(17 citation statements)

References 20 publications

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“…The diagnosis of infected necrosis is an absolute indication for antibacterial drugs [86]. Despite the fact that the majority of patients with pancreatic infection require surgical intervention, the available clinical experience suggests that conservative treatment alone with carefully targeted antibacterial therapy will suffice in certain categories of patients [87][88][89][90][91][92]. The choice of antibiotic for infected necrosis is determined by the pathogenic bacterial agent and its sensitivity to antibiotics.…”

Section: Antibacterial and Antifungal Therapy In Patients With Infectmentioning

confidence: 99%

Аntibacterial and Antifungal Therapy for Patients with Acute Pancreatitis at High Risk of Pancreatogenic Sepsis (Review)

Firsova¹,

Паршиков

Кукош

et al. 2020

Sovrem Tehnol Med

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Controlling infection is crucial in treating patients with acute pancreatitis (AP). The infectious process in AP often predisposes to subsequent sepsis by damaging not only the pancreas, but retroperitoneal tissues as well. Among other AP-associated factors, are the rapidly developing immune imbalance, the poor penetration of antimicrobial agents into necrotic tissue, and the impossibility of a single surgical debridement. Antibacterial and antifungal therapy for patients with infected necrosis and AP-associated extra-pancreatic infections remains a complex and largely unresolved problem, partially due to the high occurrence of multiresistant pathogens. The preventive use of antimicrobial agents has been discussed in the literature; however, the lack of consistent results makes it difficult to develop a unified strategy and clinical guidelines on this specific issue. Recent meta-analyses provide no conclusive evidence that antibacterial prophylaxis reduces the infection rate, mortality, or the need for surgical treatment in patients with necrotizing pancreatitis. We found only two studies indicating the benefits of using carbapenems for prophylactic purposes and one meta-analysis indicating a reduction in mortality under antibiotic treatment started no later than 72 h after the onset of the attack. Selective bowel decontamination is considered as one of the preventive anti-infection measures, although the available data may not be fully reliable. The main indications for antibacterial therapy in patients with AP are confirmed infected necrosis or extra-pancreatic infection, as well as clinical symptoms of suspected infection. Intra-arterial administration or local treatment with antibiotics can increase the efficacy of antibacterial therapy. No randomized studies on antifungal prophylaxis in AP are available; some reports though recommend using such therapy among patients at high risk of invasive candidiasis.

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Section: Antibacterial and Antifungal Therapy In Patients With Infectmentioning

confidence: 99%

Аntibacterial and Antifungal Therapy for Patients with Acute Pancreatitis at High Risk of Pancreatogenic Sepsis (Review)

Firsova¹,

Паршиков

Кукош

et al. 2020

Sovrem Tehnol Med

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“…However, there are numerous studies evaluating conservative treatment of infected necrosis [16,36,37,38]. A systematic review of 12 studies analyzed a total of 409 patients with infected pancreatic necrosis [16].…”

Section: How Conservative Can We Be?mentioning

confidence: 99%

“…Another analysis of 639 consecutive patients with necrotizing pancreatitis showed that 62% of patients can be treated without intervention and with low mortality [17]. Other authors confirmed the safety and feasibility of conservative treatment of infected pancreatic necrosis as well [36,37,38]. Looking at all the special considerations in these different studies, it is very important to point out that patients with acute necrotizing pancreatitis should be treated in specialized centers only [19,35].…”

Section: How Conservative Can We Be?mentioning

confidence: 99%

Severe Acute Pancreatitis - How Conservative Can We Be?

Alberts

Alsfasser

2018

Visc Med

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Background: Acute pancreatitis still is a disease with overall high mortality. Continuously improved understanding of the pathophysiology, however, led to changes in treatment algorithms within the last decades, thus resulting in decreased mortality. This knowledge of acute pancreatitis enabled a new classification system introduced by an international expert panel. This classification system is helpful in initiating treatment strategies which are adapted to the course of acute pancreatitis. Especially the role of surgery experienced a paradigm shift towards a more conservative approach. Methods: A specific literature search regarding the treatment of acute pancreatitis was performed in the PubMed database, and the results of key studies were compared. Results of these studies are discussed in the context of the most recent international classification system. Results and Conclusion: Based upon the available data, we can summarize that conservative treatment of acute pancreatitis with pancreatic necrosis is a valid treatment option for selected cases and is associated with reduced mortality compared to more aggressive therapy. However, patients with acute pancreatitis should be treated in experienced centers.

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“…In the last two decades, significant changes have occurred in the treatment of infected pancreatic necrosis. Namely, surgical intervention has been postponed and minimally invasive techniques have been introduced 4 - 6 .…”

Section: Introductionmentioning

confidence: 99%

“…In some situations, the intervention for drainage may be delayed to the point that the patient recovers completely, and no invasive procedure is required. Various studies have demonstrated that selected patients with infected pancreatic necrosis can be successfully managed exclusively by clinical treatment 4 , 15 - 17 . The objective of this paper is to present our experience in the management of patients with pancreatic necrosis and gas in the retroperitoneum who were treated exclusively with antibiotics and did not require any type of drainage.…”

Section: Introductionmentioning

confidence: 99%

Pancreatic Necrosis and Gas in the Retroperitoneum: Treatment with Antibiotics Alone

Rasslan

Novo

Rocha

et al. 2017

Clinics

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OBJECTIVE:To present our experience in the management of patients with infected pancreatic necrosis without drainage.METHODS:The records of patients with pancreatic necrosis admitted to our facility from 2011 to 2015 were retrospectively reviewed.RESULTS:We identified 61 patients with pancreatic necrosis. Six patients with pancreatic necrosis and gas in the retroperitoneum were treated exclusively with clinical support without any type of drainage. Only 2 patients had an APACHE II score >8. The first computed tomography scan revealed the presence of gas in 5 patients. The Balthazar computed tomography severity index score was >9 in 5 of the 6 patients. All patients were treated with antibiotics for at least 3 weeks. Blood cultures were positive in only 2 patients. Parenteral nutrition was not used in these patients. The length of hospital stay exceeded three weeks for 5 patients; 3 patients had to be readmitted. A cholecystectomy was performed after necrosis was completely resolved; pancreatitis recurred in 2 patients before the operation. No patients died.CONCLUSIONS:In selected patients, infected pancreatic necrosis (gas in the retroperitoneum) can be treated without percutaneous drainage or any additional surgical intervention. Intervention procedures should be performed for patients who exhibit clinical and laboratory deterioration.

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Surgical Versus Nonsurgical Treatment of Infected Pancreatic Necrosis: More Arguments to Change the Paradigm

Cited by 21 publications

References 20 publications

Аntibacterial and Antifungal Therapy for Patients with Acute Pancreatitis at High Risk of Pancreatogenic Sepsis (Review)

Аntibacterial and Antifungal Therapy for Patients with Acute Pancreatitis at High Risk of Pancreatogenic Sepsis (Review)

Severe Acute Pancreatitis - How Conservative Can We Be?

Pancreatic Necrosis and Gas in the Retroperitoneum: Treatment with Antibiotics Alone

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