[Four-steps surgery for infected pancreatic necrosis based on "Step-up" strategy: a retrospective study]

Area of Science:

• Gastroenterology and Hepatology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Infectious pancreatic necrosis (IPN) is a severe condition often requiring surgical intervention.
• Conventional open pancreatic necrosectomy (OPN) is associated with significant morbidity and mortality.
• Minimally invasive techniques are being explored to improve treatment outcomes for IPN.

Purpose of the Study:

• To evaluate the efficacy and safety of a novel
• four-steps
• minimally invasive treatment strategy for infectious pancreatic necrosis (IPN).
• To compare the outcomes of the
• four-steps
• approach with conventional open pancreatic necrosectomy (OPN).

Main Methods:

• Retrospective analysis of 207 patients diagnosed with IPN.
• Patients were divided into a step-up group (minimally invasive
• four-steps
• treatment) and an OPN group.
• The
• four-steps
• strategy included percutaneous catheter drainage (PCD), mini-incision access pancreatic necrosectomy (MIAPN), sinus tract endoscopic debridement, and OPN if necessary.
• Perioperative parameters and prognosis were compared between the groups using statistical tests.

Main Results:

• The step-up group had significantly lower preoperative organ failure rates (9.2% vs. 26.5%) and referral rates (28.9% vs. 47.1%) compared to the OPN group.
• Postoperative mortality (5.8% vs. 17.6%) and overall complication rates (23.1% vs. 55.9%) were significantly reduced in the step-up group.
• The step-up group experienced shorter intervals from onset to surgery, reduced operation times, and shorter hospital stays (46 vs. 52 days).
• Fewer patients in the step-up group required ICU treatment (22.0% vs. 44.1%).

Conclusions:

• The
• four-steps
• minimally invasive treatment demonstrates superiority in managing infectious pancreatic necrosis (IPN).
• Mini-incision access pancreatic necrosectomy (MIAPN) is identified as a safe and effective procedure for pancreatic tissue removal and complication reduction.
• This minimally invasive strategy offers improved clinical outcomes, including reduced mortality and morbidity, for IPN patients.