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
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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
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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)