Treatment of Necrotizing Pancreatitis: Redefining the Role of Surgery

Liao

et al. 2014

International Surgery

This study assessed the risk factors associated with mortality and the development of intra-abdominal hypertension (IAH) in patients with severe acute pancreatitis (SAP). To identify significant risk factors, we assessed the following variables in 102 patients with SAP: age, gender, etiology, serum amylase level, white blood cell (WBC) count, serum calcium level, Acute Physiology and Chronic Health Evaluation II (APACHE-II) score, computed tomography severity index (CTSI) score, pancreatic necrosis, surgical interventions, and multiple organ dysfunction syndrome (MODS). Statistically significant differences were identified using the Student t test and the χ (2) test. Independent risk factors for survival were analyzed by Cox proportional hazards regression. The following variables were significantly related to both mortality and IAH: WBC count, serum calcium level, serum amylase level, APACHE-II score, CTSI score, pancreatic necrosis, pancreatic necrosis >50%, and MODS. However, it was found that surgical intervention had no significant association with mortality. MODS and pancreatic necrosis >50% were found to be independent risk factors for survival in patients with SAP. Mortality and IAH from SAP were significantly related to WBC count, serum calcium level, serum amylase level, APACHE-II score, CTSI score, pancreatic necrosis, and MODS. However, Surgical intervention did not result in higher mortality. Moreover, MODS and pancreatic necrosis >50% predicted a worse prognosis in SAP patients.

Section: Discussionmentioning

confidence: 53%

Mortality Indicators and Risk Factors for Intra-Abdominal Hypertension in Severe Acute Pancreatitis

Liao

et al. 2014

International Surgery

J Hepato Biliary Pancreat

“…As direct diagnostic methods for infectious necrotizing pancreatitis, CT or US guided FNA can be used for bacteriological examination . In the past, the routine use of FNA was recommended when infectious necrotizing pancreatitis was suspected, but this indication has become more limited recently .…”

Section: Resultsmentioning

confidence: 99%

Japanese guidelines for the management of acute pancreatitis: Japanese Guidelines 2015

Yokoe

Takada

Mayumi

et al. 2015

365

390

The JPN Guidelines 2015 were prepared using the most up-to-date methods, and including the latest recommended medical treatments, and we are confident that this will make them easy for many clinicians to use, and will provide a useful tool in the decision-making process for the treatment of patients, and optimal medical support. The free mobile application and calculator for the JPN Guidelines 2015 is available via http://www.jshbps.jp/en/guideline/jpn-guideline2015.html.

“…Pancreatic necrosis, associated with septic conditions, determines the production of so-called infected pancreatic necrosis (IPN), a leading cause of death (Khanna et al, 2013) which can yield figures of 45% (Alsfasser et al, 2012).…”

Section: Introductionmentioning

confidence: 99%

Therapeutic Alternatives for the Treatment of Infected Pancreatic Necrosis: An Overview

2014

SUMMARY:Despite diagnostic and therapeutic advances, the treatment of infected pancreatic necrosis (IPN) continues to be a complex problem to solve. The aim of this study is to evaluate the effectiveness of different surgical alternatives for the treatment of IPN. Articles published between 2000 to 2013, and related to effectiveness of open surgery (OS) and minimally invasive treatmente (MIT) in patients with IPN were evaluated. PubMed, MEDLINE, The Cochrane Database of Systematic Reviews, Cochrane Central Register RCT, DARE, IBECS, SciELO, LILACS, PAHO, WHOLIS, ASERNIP-S, NIHR, HTA, Clinical Excellence, York Health Economic Consortium and Tripdatabase were reviewed, searching systematic reviews (SR), randomized clinical trials (RCT) and observational studies (OST), in which the effectiveness of OS and MIT was evaluated in relation to the variables mortality, intra-abdominal bleeding, development of enterocutaneous fistula or hollow viscera perforation, development of pancreatic fistula, reoperations for complications, reoperations for new necrosectomy, development of diabetes mellitus and pancreatic enzyme requirements. Three hundred eighty-nine articles were retrieved, 10 of which met the selection criteria (2 SR, 1 RCT and 7 OST). The studies have a level of evidence of 2a, 2b, 3a and 4. MIT are associated with better results than OS in all variables analyzed, but significantly only in the development of diabetes mellitus and pancreatic enzyme requirement. Articles found are few and heterogeneous, making meaningful conclusions difficult. Studies with a better level of evidence, methodological quality and population size are needed to make conclusions and recommendations.