Negative pressure irrigation and endoscopic necrosectomy through man-made sinus tract in infected necrotizing pancreatitis: a technical report

BMC Surgery, Nov 2016

Background In recent years, a step-up approach based on minimally invasive techniques was recommended by latest guidelines as initial invasive treatment for infected pancreatic necrosis (IPN). In this study, we aimed to describe a novel step-up approach for treating IPN consisting of four steps including negative pressure irrigation (NPI) and endoscopic necrosectomy (ED) as a bridge between percutaneous catheter drainage (PCD) and open necrosectomy Methods A retrospective review of a prospectively collected internal database of patients with a diagnosis of IPN between Jan, 2012 to Dec, 2012 at a single institution was performed. All patients underwent the same drainage strategy including four steps: PCD, NPI, ED and open necrosectomy. The demographic characteristics and clinical outcomes of study patients were analyzed. Results A total of 71 consecutive patients (48 males and 23 females) were included in the analysis. No significant procedure-related complication was observed and the overall mortality was +21.1 % (15 of 71 patients). Seven different strategies like PCD+ NPI, PCD+NPI+ED, PCD+open necrosectomy, etcetera, were applied in study patients and a half of them received PCD alone. In general, each patient underwent a median of 2 drainage procedures and the median total drainage duration was 11 days (interquartile range, 6–21days). Conclusions This four-step approach is effective in treating IPN and adds no extra risk to patients when compared with other latest step-up strategies. The two novel techniques (NPI and ED) could offer distinct clinical benefits without posing unanticipated risks inherent to the procedures.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

http://www.biomedcentral.com/content/pdf/s12893-016-0190-x.pdf

Negative pressure irrigation and endoscopic necrosectomy through man-made sinus tract in infected necrotizing pancreatitis: a technical report

Tong et al. BMC Surgery Negative pressure irrigation and endoscopic necrosectomy through man- made sinus tract in infected necrotizing pancreatitis: a technical report Zhihui Tong 1 3 Lu Ke 1 3 Baiqiang Li 1 3 Gang Li 1 3 Jing Zhou 1 3 Xiao Shen 1 3 Weiqin Li 0 1 3 Ning Li 2 Jieshou Li 2 0 Department of SICU, Research Institute of General Surgery, Jinling Hospital , 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province , China 1 SICU, Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine , Nanjing 210002 , People's Republic of China 2 Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine , Nanjing 210002 , People's Republic of China 3 SICU, Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine , Nanjing 210002 , People's Republic of China Background: In recent years, a step-up approach based on minimally invasive techniques was recommended by latest guidelines as initial invasive treatment for infected pancreatic necrosis (IPN). In this study, we aimed to describe a novel step-up approach for treating IPN consisting of four steps including negative pressure irrigation (NPI) and endoscopic necrosectomy (ED) as a bridge between percutaneous catheter drainage (PCD) and open necrosectomy Methods: A retrospective review of a prospectively collected internal database of patients with a diagnosis of IPN between Jan, 2012 to Dec, 2012 at a single institution was performed. All patients underwent the same drainage strategy including four steps: PCD, NPI, ED and open necrosectomy. The demographic characteristics and clinical outcomes of study patients were analyzed. Results: A total of 71 consecutive patients (48 males and 23 females) were included in the analysis. No significant procedure-related complication was observed and the overall mortality was +21.1 % (15 of 71 patients). Seven different strategies like PCD+ NPI, PCD+NPI+ED, PCD+open necrosectomy, etcetera, were applied in study patients and a half of them received PCD alone. In general, each patient underwent a median of 2 drainage procedures and the median total drainage duration was 11 days (interquartile range, 6-21days). Conclusions: This four-step approach is effective in treating IPN and adds no extra risk to patients when compared with other latest step-up strategies. The two novel techniques (NPI and ED) could offer distinct clinical benefits without posing unanticipated risks inherent to the procedures. Infected pancreatic necrosis; Negative pressure irrigation; Endoscopic necrosectomy; Percutaneous catheter drainage - Background Secondary infection of pancreatic necrosis (IPN), either pancreatic or peripancreatic, has been proved to be one of the most important determinants of severity in patients with acute necrotizing pancreatitis [1]. When compared with patients with sterile necrosis, patients with IPN suffered substantial increase in mortality ranging from 14 to 69 % due to sepsis and multiple organ failure, despite advances in critical care and antibiotics [2]. Traditionally, primary open necrosectomy has long been center of treatment in IPN patients [3], but in recent years, a step-up approach based on minimally invasive techniques was recommended by latest guidelines as initial invasive treatment [4]. In previous studies, percutaneous catheter drainage (PCD) is the cornerstone of step-up approaches and open necrosectomy always the last choice for those who did not respond to minimally invasive treatment [3]. However, techniques using © The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. either endoscope or laparoscope applied between PCD and open necrosectomy vary in different studies [5–8] and the optimal choice remains unknown. In the present study, we aimed to describe both the technical and clinical aspects of a new step-up approach for treating IPN consisting of four steps including negative pressure irrigation (NPI) and endoscopic necrosectomy (ED) as a bridge between PCD and open necrosectomy. By evaluating its feasibility and safety, we aimed to establish a framework for further studies comparing clinical effectiveness of currently available minimally invasive strategies. Methods Using an prospectively collected internal database, a retrospective review on all patients with a diagnosis of IPN between Jan, 2012 and Dec, 2012 at the Jinling Hospital, Nanjing University was performed (...truncated)


This is a preview of a remote PDF: http://www.biomedcentral.com/content/pdf/s12893-016-0190-x.pdf

Zhihui Tong, Lu Ke, Baiqiang Li, Gang Li, Jing Zhou, Xiao Shen, Weiqin Li, Ning Li, Jieshou Li. Negative pressure irrigation and endoscopic necrosectomy through man-made sinus tract in infected necrotizing pancreatitis: a technical report, BMC Surgery, 2016, pp. 73, 16, DOI: 10.1186/s12893-016-0190-x