Selective Necrosectomy for Infected Pancreatic Necrosis

Area of Science:

• Gastroenterology
• Interventional Radiology
• Surgical Management

Background:

• Infected pancreatic necrosis (IPN) traditionally required necrosectomy, carrying high morbidity and mortality (>20%).
• Percutaneous drainage was previously used to delay necrosectomy, showing improved outcomes.

Purpose of the Study:

• To evaluate a management strategy of percutaneous drainage with selective deferred necrosectomy for infected pancreatic necrosis.
• To assess the efficacy and outcomes of this minimally invasive approach.

Main Methods:

• A retrospective review of 38 consecutive patients with IPN managed from January 2008 to December 2014.
• All patients underwent percutaneous radiological drainage; necrosectomy was selectively performed for non-resolving necrosis.

Main Results:

• 38 patients underwent percutaneous drainage; 15 required selective necrosectomy.
• 23 patients were managed non-surgically with drainage, nutritional support, and critical care.
• Overall mortality was significantly reduced to 5% (n=2).

Conclusions:

• Radiological-guided drainage is effective for infected pancreatic collections, often proving curative.
• This approach facilitates delayed surgical intervention when necessary, leading to improved patient outcomes and reduced mortality.