[Pancreatic necrosis: pro surgical therapy]

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Abdominal Surgery

Background:

• Severe necrotizing pancreatitis often requires intervention for infection and septic complications.
• The step-up approach, starting with drainage, is standard for managing infected necrosis.
• Necrosectomy is indicated for persistent or worsening clinical deterioration.

Purpose of the Study:

• To review current treatment strategies for severe necrotizing pancreatitis.
• To evaluate the role and timing of necrosectomy.
• To compare open necrosectomy with minimally invasive techniques.

Main Methods:

• Review of current literature and clinical guidelines.
• Discussion of the step-up approach including interventional and endoscopic drainage.
• Analysis of open necrosectomy and minimally invasive necrosectomy techniques (retroperitoneoscopic, endoscopic transgastric).

Main Results:

• Interventional or endoscopic drainage is the primary treatment for infected necrotizing pancreatitis.
• Necrosectomy is indicated for refractory cases, ideally delayed to 3-4 weeks post-onset.
• Minimally invasive necrosectomy techniques are feasible in ~70% of cases, but their benefit in reducing organ failure is unproven.

Conclusions:

• The step-up approach with delayed necrosectomy is crucial for managing severe necrotizing pancreatitis.
• Open necrosectomy remains a safe option with good outcomes.
• Minimally invasive techniques offer alternatives, but further research is needed to confirm reduced postoperative organ failure.