Abstract
Objective. To evaluate the results of treatment using minimally invasive interventions and open necrectomy in patients with infected acute pancreatitis.
 Materials and methods. A retrospective cohort two-centered analysis was performed in 211 patients with infected acute pancreatitis who divided into two groups: the first included 101 patients, in the treatment of which used open surgery; the second included 110 patients, in the treatment of which used treatment tactic step-up approach.
 Results. In the first group used open necrosectomy with drainage for postoperative lavage (75 patients, 74.3%), including open packing with planned re-laparotomy (8 patients, 7.9%), and omentobursostomy for necrosectomy after surgery (18 patients, 17.8%). Postoperative complications occurred in 58 (57.4%), after the surgery 34 (33.7%) patients was died: 30 had a thirty-day mortality, and 4 had a ninety-day mortality. In the second group group, 72 (65.5%) patients were treated by percutaneous catheter drainage, 6 (5.5%) by video-assisted retroperitoneal debridement and drainage, 5 (4.5%) by through the wall of the stomach or duodenum in the infected pseudocyst and open necrosectomy was performed on 27 (24.5%) patients. Postoperative complications occurred in 37 (33.6%) patients, after the surgery 19 (17.3%) was died: 15 had a thirty -day mortality and 4 had a ninety-day mortality. In the regression analysis, only the presence of multiple organ dysfunction before (AUC = 0.867) and after surgery (AUC = 0.930) significantly affected postoperative mortality, but the effect of the prevalence of pancreatic necrosis (AUC = 0.693) on mortality was limited. Differences were likely between groups (χ2=7.282, p=0.026).
 Conclusion. The surgical treatment should be initiated with a minimally invasive procedures and combination these operations with open surgery was able to reduce complications and mortality in the patients with infected acute pancreatitis.
Highlights
Acute pancreatitis (AP) is one of the most common gastrointestinal conditions worldwide, requiring acute hospital admission
Despite surgery being effective for infected pancreatic necrosis, it carries with high risk of mortality
The main data of patients of the first and second groups are presented in Table 1, which did not differ significantly between the two groups, and infected complications of AP was documented in similar proportions of patients in the two groups
Summary
Acute pancreatitis (AP) is one of the most common gastrointestinal conditions worldwide, requiring acute hospital admission. In the current International Treatment Guideline of AP in 2013 recommended a step–up approach to treatment this disease with necrosectomy as late as possible [4] These recommendations are based on the results of the Dutch PANTER trial [5] and have been tested in other studies, such as TENSION [6] and POINTER [7]. The first step in this step–up approach is the drainage of fluid collection and complex conservative treatment with intravenous antibiotics, which can eliminate the need for any intervention in a certain percentage of patients. If this stage does not eliminate the clinical signs of infection and sepsis, the second step is performed in the form of surgical or endoscopic necrosectomy [8]. Improved diagnosis and changed in the treatment of acute pancreatitis, such as minimally invasive radiologic, endoscopic and laparoscopic procedures, allow some patients completely avoid surgery and open necrosectomy, and for some of them these procedures to delay the development of sepsis when they undergo open necrosectomy, which helps reduce complications and mortality [9]
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