Percutaneous Interventions for Necrotic Suppurative Complications of Pancreonecrosis

Abstract

Aim. To determine criteria of efficiency, duration and advisability for only minimally invasive treatment of necrotic suppurative complications of acute severe pancreatitis.
Material and Methods. The research is based on results of treatment of 115 patients with necrotic suppurative complications of acute severe pancreatitis. Patients were divided into 2 groups: the first included 33 (28.7%) patients who received conventional operation; the second – 82 (71.3%) patients who underwent primarily minimally invasive interventions.

Results. Postoperative complications were observed in 6 (18%) patients from the first group including arrosive hemorrhage (5 cases), colic fistula (1 case). Mortality rate among patients of moderate severity was 39.3%, in case of severe condition – 36.3%. There were postoperative complications in 19 (23%) patients from the second group including arrosive hemorrhage (5 cases), colic fistula (11 cases) and pancreatic fistula (14 cases). Overall mortality rate was 23%. In the second group mortality was 2 times lower and duration of hospital-stay – about 1.5 times longer.

Conclusion. Minimally invasive techniques under ultrasonic and X-ray control may be always performed in patients with necrotic suppurative complications of acute severe pancreatitis. However in case of intoxication syndrome retention during 20 days postoperatively it is necessary to take decision about adequate necrosequestrectomyusing laparotomy or laparoscopy