Open necrosectomy combined with continuous positive drainage and prophylactic diverting loop ileostomy for late infected pancreatic necrosis: a retrospective cohort study

Dong-Guang Niu,Lian-An Ding,Yun-Zhao Zhao,Wei-Qin Li,Qian Huang,Wei-Liang Tian,Fan Yang,Hong-Chun Fang,Chen Li

doi:10.1186/s12876-020-01343-7

Abstract

BackgroundTo evaluate an innovative open necrosectomy strategy with continuous positive drainage and prophylactic diverting loop ileostomy for the management of late infected pancreatic necrosis (LIPN).MethodsConsecutive patients were divided into open necrosectomy (ON) group (n = 23), open necrosectomy with colonic segment resection (ON+CSR) group (n = 8) and open necrosectomy with prophylactic diverting loop ileostomy (ON+PDLI) group (n = 11). Continuous positive drainage (CPD) via double-lumen irrigation–suction tube (DLIST) was performed in ON+PDLI group. The primary endpoints were duration of organ failure after surgery, postoperative complication, the rate of re-surgery and mortality. The secondary endpoints were duration of hospitalization, cost, time interval between open surgery and total enteral nutrition (TEN).ResultsThe recovery time of organ function in ON+PDLI group was shorter than that in other two groups. Colonic complications occurred in 13 patients (56.5%) in the ON group and 3 patients (27.3%) in the ON+PDLI group (p = 0.11). The length of stay in the ON+PDLI group was shorter than the ON group (p = 0.001). The hospitalization cost in the ON+PDLI group was less than the ON group (p = 0.0052).ConclusionON+PDLI can avoid the intestinal dysfunction, re-ileostomy, the resection of innocent colon and reduce the intraoperative trauma. Despite being of colonic complications before or during operation, CPD + PDLI may show superior effectiveness, safety, and convenience in LIPN.

Highlights

To evaluate an innovative open necrosectomy strategy with continuous positive drainage and prophylactic diverting loop ileostomy for the management of late infected pancreatic necrosis (LIPN)
The inclusion criteria for the study were: (1) patients diagnosis with IPN according to the presence of gas bubbles within pancreatic necrosis on contrast-enhanced CT scan or a positive bacterial culture obtained by fineneedle aspiration, first drainage and/or operation [18]; (2) patients performed with open pancreatic necrosectomy and diagnosed with IPN
Patient characteristics From January 2012 to December 2017, a total of 234 patients with IPN were admitted to our hospital, of which 65 patients were performed with open surgery

Summary

Introduction

To evaluate an innovative open necrosectomy strategy with continuous positive drainage and prophylactic diverting loop ileostomy for the management of late infected pancreatic necrosis (LIPN). A certain proportion of patients with SAP would develop infected pancreatic necrosis (IPN) in the later course of the disease [1]. Resection with proximal ostomy and diverting loop ileostomy (DLI) constitutes the treatment for suspected imminent or overt ischemia/perforation in majority of cases [11, 12]. Up to now, comparing the role of DLI and the aggressive form of treatment such as subtotal/segment colectomy in terms of clinic outcome and prognosis, there is no data to suggest that which one is more advantageous in treating IPN patients with the suspected imminent or overt ischemia/perforation before or during operation. There is no report about the merits of PDLI in ON for IPN without colonic complications before or during operation

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