Analysis of residual pancreatic bed necrosis using computed tomography following minimally invasive necrosectomy
Ahmed Hamouda1, Steve Romans, Hanna Davidson
1Hepato-pancreatico-biliary Unit, Royal Surrey County Hospital, Guildford, Surrey, England. ahmedhamouda@hotmail.com
Purpose:
In a unit practicing minimally invasive pancreatic necrosectomy (MIPN), our aim was to assess whether tomographic residual necrotic volume was an objective indicator for repeat necrosectomy.
Methods:
Prospective study of acute pancreatitis admissions. Patients with infected pancreatic necrosis or deteriorating sepsis had MIPN. Outcome parameters included necrotic volumes, conversion rate, morbidity, and mortality.
Results:
Thirty patients were admitted with acute pancreatitis of which 15 required organ support. Twenty-nine necrosectomy sessions were performed. Average time from admission to necrosectomy was 39.7 days with an internecrosectomy interval of 6 to 14 days. Mean reduction of necrosis volume was 89.5% and postnecrosectomy volumes were variable. Mean length of hospital and intensive care unit stay was 124.3 and 40.2 days, respectively. Complications included bleeding, pancreatic fistula, and gastric outlet obstruction. No in-hospital deaths or conversions occurred.
Conclusion:
Frequent MIPN achieves substantial pancreatic bed volume reduction with no conversions. Repetitive tomographic scanning is of limited use as an indicator for renecrosectomy.
Insights
Minimally invasive pancreatic necrosectomy (MIPN) effectively reduces necrotic volume in acute pancreatitis patients. However, repeat imaging is not a reliable indicator for further necrosectomy procedures.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Critical Care Medicine
Background:
- Acute pancreatitis can lead to infected pancreatic necrosis, a severe complication.
- Minimally invasive pancreatic necrosectomy (MIPN) is an evolving treatment approach.
- Assessing the need for repeat interventions is crucial for patient outcomes.
Purpose of the Study:
- To evaluate tomographic residual necrotic volume as an objective marker for repeat necrosectomy.
- To assess the efficacy and safety of MIPN in a dedicated unit.
- To determine the utility of imaging in guiding further interventions.
Main Methods:
- Prospective study of acute pancreatitis admissions.
- Patients with infected necrosis or sepsis underwent MIPN.
- Outcome measures included necrotic volume, conversion rates, morbidity, and mortality.
Main Results:
- MIPN achieved an 89.5% mean reduction in necrotic volume.
- Twenty-nine necrosectomy sessions were performed across 30 patients.
- No in-hospital deaths or conversions to open surgery were observed.
Conclusions:
- Frequent MIPN leads to significant pancreatic necrosis volume reduction without conversions.
- Repetitive tomographic scanning has limited value in indicating the need for repeat necrosectomy.
- MIPN is a safe and effective treatment for infected pancreatic necrosis.
