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Author Spotlight: Advancements in Retroperitoneal Approach for Necrotizing Pancreatitis
Published on: March 15, 2024
Comparison between minimally invasive and open surgical treatment in necrotizing pancreatitis
Marek Wroński1, Włodzimierz Cebulski1, Bartosz Witkowski2
1Department of General, Gastroenterological and Oncological Surgery, Medical University of Warsaw, Warsaw, Poland.
Background:
Minimal access techniques have gained popularity for the management of necrotizing pancreatitis, but only a few studies compared open necrosectomy with a less invasive treatment. The aim of this study was to evaluate the outcomes of minimally invasive treatment for necrotizing pancreatitis in comparison with open necrosectomy.
Materials And Methods:
This retrospective study included 70 patients who underwent minimally invasive intervention or open surgical debridement for necrotizing pancreatitis between January 2007 and December 2014. Data were analyzed for postoperative morbidity and outcome.
Results:
Of 70 patients, 22 patients underwent primary open necrosectomy and 48 patients were treated with minimally invasive techniques. Percutaneous and endoscopic drainage were successful in 34.9% and 75.0% of patients, respectively. The rates of postoperative new-onset organ failure and intensive care unit stay were significantly lower in the minimally invasive group (25.0% versus 54.5%; P = 0.016, and 29.2% versus 54.5%; P = 0.041, respectively). Gastrointestinal fistulas occurred more frequently after primary open necrosectomy (36.4% versus 10.4%; P = 0.009). Mortality was comparable in both groups (18.6% versus 27.3%; P = 0.420). Mortality for salvage open necrosectomy was similar to that for primary open debridement (28.6% versus 27.3%; P = 0.924). The independent risk factors for major postoperative complications were primary open necrosectomy (P = 0.028) and shorter interval to first intervention (P = 0.020). Mortality was independently associated only with older age (P = 0.009).
Conclusions:
Minimally invasive treatment should be preferred over open necrosectomy for initial management of necrotizing pancreatitis.
Insights
Minimally invasive treatment for necrotizing pancreatitis leads to fewer complications and shorter intensive care unit stays compared to open necrosectomy. These less invasive approaches should be the preferred initial management strategy.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Pancreatic Diseases
Background:
- Necrotizing pancreatitis management is evolving.
- Minimal access techniques are increasingly favored.
- Limited comparative studies exist between open and minimally invasive necrosectomy.
Purpose of the Study:
- To compare outcomes of minimally invasive treatment versus open necrosectomy for necrotizing pancreatitis.
- To evaluate postoperative morbidity and mortality rates.
- To identify risk factors for complications.
Main Methods:
- Retrospective study of 70 patients (2007-2014).
- Patients underwent either minimally invasive intervention or open surgical debridement.
- Data analysis focused on postoperative morbidity and outcomes.
Main Results:
- Minimally invasive group had significantly lower rates of new-onset organ failure (25.0% vs 54.5%) and ICU stay (29.2% vs 54.5%).
- Gastrointestinal fistulas were more frequent after open necrosectomy (36.4% vs 10.4%).
- Mortality rates were comparable between groups (18.6% vs 27.3%).
Conclusions:
- Minimally invasive treatment is associated with better outcomes.
- Open necrosectomy is an independent risk factor for major complications.
- Minimally invasive approaches are recommended for initial management.
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