Results of using transfistula videoscopic necrosequestrectomy to treat purulent-necrotic parapancreatitis

Aim. To improve the efficacy of minimally invasive surgical treatment for infected pancreatic necrosis.

Materials and methods. The study analyzed the data of 142 patients with moderate to severe infected pancreatic necrosis treated from 2012 to 2017. In 2012–2014, an incision and drainage procedure involving multiple drainage replacements and debridements was used in 84 (59.2%) patients comprising Group 1. Since 2015, 58 (40.8%) patients comprising Group 2 have been treated using large-diameter (30–32 Fr) tube drainage followed by debridement and transfistula videoscopic necrosequestrectomy.

Results. The best results were obtained by draining pathological cavities using large-diameter double-lumen drainage, as well as by actively removing sequestra using the developed technique of transfistula videoscopic necrosequestrectomy. In Group 2, the incidence of local complications amounted to 6.8% as compared to 22.6% in Group 1. Group 2 exhibited significantly lower case mortality rate (12.3% and 19.4%; t = 2.1; p ≤ 0.05), while patients in Group 1 required longer hospitalization: 96 ± 7.4 days as compared to 71 ± 3.2 days in Group 2 (t = 2.9 p ≤ 0.05).

Conclusion. Minimally invasive procedures involving transfistula videoscopic necrosequestrectomy improve treatment outcomes, as well as reducing case mortality rate in the setting of purulent-necrotic parapancreatitis.

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