UK guidelines for the management of acute pancreatitis

Ireland,

doi:10.1136/gut.2004.057026

Cited by 438 publications

(184 citation statements)

References 57 publications

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confidence: 99%

“…[1][2][3][4][5][6][7][8] Tissue is loose, friable and much vascularized; so, pancreatitis and major bleedings are well-described during surgery. 1 Approximately 20% of patients with acute pancreatitis develop pancreatic necrosis, and mortality rates up to 39% have been reported. [1][2][3][4][5][6][7][8] Surgical debridement (so-called necrosectomy) is the traditional management of necrotizing pancreatitis with specific indications.…”

mentioning

confidence: 99%

“…1 Approximately 20% of patients with acute pancreatitis develop pancreatic necrosis, and mortality rates up to 39% have been reported. [1][2][3][4][5][6][7][8] Surgical debridement (so-called necrosectomy) is the traditional management of necrotizing pancreatitis with specific indications. [1][2][3][4][5][6][7][8][9] In severe AP, current indications for surgery include the presence of infected pancreatic necrosis, extensive sterile necrosis in patients in whom symptoms have failed to resolve despite maximal conservative treatment or in patients who develop catastrophic complications related to pancreatic necrosis such as bleeding, visceral perforation or infarction.…”

mentioning

confidence: 99%

“…1 With a national age-adjusted incidence rate of 12.3 per 100,000, approximately 46,420 individuals were diagnosed with pancreatic cancer in 2014. Although the disease is relatively rare, pancreatic cancer is one of the most fatal cancers among adults in the United States.…”

mentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] Surgical debridement (so-called necrosectomy) is the traditional management of necrotizing pancreatitis with specific indications. [1][2][3][4][5][6][7][8][9] In severe AP, current indications for surgery include the presence of infected pancreatic necrosis, extensive sterile necrosis in patients in whom symptoms have failed to resolve despite maximal conservative treatment or in patients who develop catastrophic complications related to pancreatic necrosis such as bleeding, visceral perforation or infarction. [1][2][3][4][5][6][7][8] The Computed Tomography (CT) evaluation of necrotic pancreatitis often show a superficial necrosis of the gland that contains vital tissue, this has led to gradually abandoning the performance of demolitive resection in favor of a treatment that combines the debridement of necrotic tissue associated with different draining techniques and postoperative cleaning procedures with open or closed packing.…”

mentioning

confidence: 99%

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Evaluation of the Best Power Setting of Laser Waves in Pancreatic Surgery: ECHO ND-YAG Laser Ablation on Bovine Pancreatic Tissue

Dioscoridi¹,

Sordi²,

Breschi³

et al. 2016

Pancreas Open J

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Research ABSTRACTBackground: Pancreatic surgery is one of the most difficult and life-threatening surgical therapy especially during necrotizing pancreatitis and advanced solid neoplasms. Aim of the study: To evaluate the possibility to use ECHO Neodymium-Doped Yttrium Aluminium Garnet (ND-YAG) laser in pancreatic surgery and to establish the best power setting for the application on pancreatic tissue. Methods: An ECHO Laser ND-YAG 1064 nm, at the constant fluence of 1800 J/cm 2 was used. The laser waves were inserted inside of the samples with optical fibers of 500 micron diameter for a pre-established timing (11 min, 6 min, 4 min) in order to reach the constant fluence. Samples were, then, prepared for hystological examination. Results: At 3W power setting, the pancreatic tissue was not macroscopically modified except for an increased cutting consistency. Histological examination showed no substantial microscopical differences in pancreatic cells that appeared only partially burnt (in fact, nuclei and membranes are still recognizable). The vessels in the surrounding area have the normal morphological aspects. At 5W, macroscopically the presence of a completely burnt area, corresponding to the site of direct interaction of laser and tissue, was found and the surrounding tissue did not appear substantially modified. Histological examination showed the complete absence of cells in the burnt area and an important heat damage of the surrounding cells till the 2 th centimeter from the site of laser application. The vessels in the heat damage area appeared completely coagulated. At the power of 7 W, the burnt area was about twice than in the previous setting and histological examination showed the complete absence of cells in the burnt area and a larger heat damage of the nearest cells (till the 4 th centimeter from the application site). The vessels in heat damage area were found completely coagulated. Conclusions: A power setting between 4 and 6 W have been found as the best one for laser application on pancreatic tissue because a complete destruction of the cells in the site of application but a limited heat damage in the surrounding healthy cells have been obtained.

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