Abstract
BackgroundIn 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 necrosectomyMethodsA 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.ResultsA 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).ConclusionsThis 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12893-016-0190-x) contains supplementary material, which is available to authorized users.
Highlights
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)
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]
Tong et al BMC Surgery (2016) 16:73 either endoscope or laparoscope applied between percutaneous catheter drainage (PCD) and open necrosectomy vary in different studies [5,6,7,8] and the optimal choice remains unknown
Summary
A step-up approach based on minimally invasive techniques was recommended by latest guidelines as initial invasive treatment for infected pancreatic necrosis (IPN). 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. 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
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