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Can infected pancreatic necrosis really be managed conservatively?

Bilal Al-Sarireh1, Nicholas G Mowbray, Ali Al-Sarira

  • 1Department of General Surgery, ABM University Health Board, Swansea, UK.

European Journal of Gastroenterology & Hepatology
|August 28, 2018
PubMed
Abstract

Insights

Antibiotics alone can effectively treat infected pancreatic necrosis (IPN) in select stable patients, avoiding surgery and reducing complications like pancreatic insufficiency. This conservative approach offers a viable alternative to invasive procedures.

Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Infectious Disease Management

Background:

  • Current guidelines favor minimally invasive drainage over open surgery for infected pancreatic necrosis (IPN).
  • The study explores extending conservative management further with an antibiotics-only protocol for IPN.

Purpose of the Study:

  • To evaluate the efficacy of an antibiotics-only protocol for treating infected pancreatic necrosis (IPN).
  • To compare outcomes of antibiotic-only treatment with minimal access retroperitoneal pancreatic necrosectomy (MARPN).

Main Methods:

  • A retrospective analysis of 33 patients with IPN treated with carbapenem antibiotics for at least 6 weeks.
  • Comparison with 44 patients who underwent MARPN for IPN.

Main Results:

  • The antibiotics-only group had no disease-specific mortality and one case of pancreatic insufficiency.
  • The MARPN group experienced 20% mortality and 81.8% pancreatic insufficiency.
  • Antibiotic-treated patients had lower severity scores and better inflammatory markers.

Conclusions:

  • Antibiotics-only treatment is a valid option for hemodynamically stable IPN patients with less severe disease.
  • Careful patient selection by experienced clinicians is crucial for successful conservative management of IPN.

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