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[Comparison of minimal invasive technologies for treatment of infected pancreatic necrosis]
E A Gallyamov1, M A Agapov2, Yu B Busyrev1
1Sechenov First Moscow State Medical University of the Ministry of Health of Russia, Moscow, Russia.
Aim:
the assessment of the role of minimally invasive interventional procedures in the treatment of patients with infected pancreatic necrosis and their safety, as well as comparison of the results of the most common modern minimally invasive techniques among themselves.
Methods:
The results of treatment of 310 patients are presented with infected destructive pancreatitis from 2013 to 2018 on the basis of the city clinical hospital named after I.V. Davydovsky. The patients were divided into three groups: in the first one (n=170) patients underwent puncture followed by drainage of necrotic foci under ultrasound and CT control, in the second (n=98) patients underwent sanation of foci completely by laparoscopic access, in the third (n=42) a series of retroperitoneoscopy was used for the same purpose.
Results:
In 114 (67.1%) cases, patients from the first group did not require further surgical intervention. The results of percutaneous drainage were successful. The average length of hospital stay in the first group was 27 days, in the second and third groups - 31 days (the ratio in the 2nd and 3rd groups was 1.03 (95% CI 0.97-1.08; p<0.05)). In the course of treatment, complications were identified in 35 (35.7%) patients in the 2nd and 17 (40.4%) patients in the 3rd group (ratio 0.88 (95% CI 0.82-0.94)). There were 22 (7.1%) deaths. The causes of death were: 1 (0.3%) of the patient had arrosive bleeding, 2 (0.7%) had duodenal fistulas, 19 (6.1%) multiple organ failure against the background of widespread retroperitoneal phlegmon.
Conclusion:
The efficacy of treatment of infected pancreatic necrosis depends on the possibility of full drainage of the necrotic focus, regardless of approach. Minimally invasive techniques can reduce intraoperative trauma by reducing the wound surface, which contribute to develop systemic inflammatory response syndrome.
Insights
Minimally invasive procedures effectively treat infected pancreatic necrosis by enabling full drainage of necrotic foci. These techniques reduce trauma, leading to better patient outcomes and potentially fewer complications compared to traditional surgery.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Interventions
- Critical Care Medicine
Background:
- Infected pancreatic necrosis presents significant treatment challenges.
- Minimally invasive interventional procedures offer a potential alternative to open surgery.
- Assessing the safety and efficacy of these techniques is crucial.
Purpose of the Study:
- To evaluate the role and safety of minimally invasive procedures in treating infected pancreatic necrosis.
- To compare the outcomes of different minimally invasive techniques: percutaneous drainage, laparoscopic, and retroperitoneoscopic sanation.
- To determine the factors influencing treatment success.
Main Methods:
- A retrospective analysis of 310 patients with infected destructive pancreatitis treated between 2013 and 2018.
- Patients were divided into three groups: percutaneous drainage (n=170), laparoscopic sanation (n=98), and retroperitoneoscopic sanation (n=42).
- Outcomes including need for further surgery, length of stay, complications, and mortality were assessed.
Main Results:
- Percutaneous drainage was successful in 67.1% of patients, often avoiding further surgery.
- Average hospital stay was 27 days for percutaneous drainage versus 31 days for laparoscopic/retroperitoneoscopic approaches.
- Complication rates were 35.7% (laparoscopic) and 40.4% (retroperitoneoscopic), with an overall mortality of 7.1%.
Conclusions:
- Effective treatment of infected pancreatic necrosis hinges on complete drainage of necrotic areas, irrespective of the approach.
- Minimally invasive techniques minimize intraoperative trauma by reducing wound surface area.
- These approaches may mitigate the systemic inflammatory response syndrome.
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