Minimally Invasive Interventions for Infected Pancreatic Necrosis
https://doi.org/10.16931/1995-5464.20153110-116
Abstract
Aim. To examine the effectiveness of minimally invasive interventions for infected pancreatic necrosis (purulent necrotic
parapancreatitis).
Material and Methods. A simple comparative multicenter study included 270 patients with infected pancreatic necrosis who were treated for the period from 2004 to 2013. Paients were divided into three groups: 1 group – 90 patients who underwent only remedial laparotomy. 2 group – 90 patients who had minimally invasive drainage as the first stage followed by subsequent remedial
laparotomy. 3 group – 90 patients with only minimally invasive drainage. Patients distribution by age, comorbidities, severity of purulent necrotic parapancreatitis and therapeutic medical complex was homogeneous.
Results. There were maximal incidence of complications (digestive fistula, bleeding, RDS, severe sepsis) and mortality rate in group 1. In group 2 there was a tendency to decrease of morbidity and mortality in infected pancreatic necrosis patients although their level remained high. Minimally invasive interventions (3 group) for infected pancreatic necrosis resulted significant reduction of morbidity and mortality.
Conclusion. Minimally invasive techniques should be preferred for primary drainage of infected pancreatic necrosis (purulent necrotic parapancreatitis). Laparotomy with necrosectomy is necessary in case of ineffectiveness of minimally invasive drainage or appearance of complications that can not be treated using minimally invasive interventions
About the Authors
A. V. Andreev
Department of X-ray and Ultrasonic Diagnosis and Treatment Methods, Regional Clinical Hospital № 2, Krasnodar
Russian Federation
Russian Federation
Doct. of Med. Sci., Head of the Department of X-ray and Ultra-sonic Diagnosis and Treatment Methods, Regional Clinical Hospital № 2, Krasnodar
V. G. Ivshin
Chair of Surgical Diseases №1, Medical Institute of Tula State University
Russian Federation
Russian Federation
Doct. of Med. Sci., Professor, Head of the Chair of Surgical Diseases №1, Medical Institute of Tula State University, General Director of Center of New Medical Technologies
V. R. Goltsov
Department of Pancreatology, City Panсreatic Center of I.I. Dzhanelidze Saint-Petersburg Research Institute of Emergency Care
Russian Federation
Russian Federation
Doct. of Med. Sci., Head of the Department of Pancreatology, City Panсreatic Center of I.I. Dzhanelidze Saint-Petersburg Research Institute of Emergency Care
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Review
For citations:
Andreev A.V., Ivshin V.G., Goltsov V.R. Minimally Invasive Interventions for Infected Pancreatic Necrosis. Annaly khirurgicheskoy gepatologii = Annals of HPB Surgery. 2015;20(3):110-116. (In Russ.) https://doi.org/10.16931/1995-5464.20153110-116
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