Outcome assessment of surgical management of local complications of acute pancreatitis: An observational study

Abstract

Aim: To evaluate the indication and outcome of different surgical management modalities in local complications of acute pancreatitis. Methodology: A hospital-based observational study was conducted in the department of surgery Shri Shankaracharya Institute of medical sciences, Bhilai, India after approval from the institutional ethical committee. A purposive sampling method was utilized to recruit the patients. Patients who underwent laparoscopic or open surgical procedures transperitoneal or retroperitoneal for the management of local complications of acute pancreatitis for the period of 1 year were included. Clinical, laboratory and imaging findings including, contrast-enhanced CT scan findings of all the cases, were recorded as per the proforma. In addition, the indication of each procedure, perioperative outcome and associated complications were evaluated in all the studied cases. All minimally invasive procedures were performed under general anesthesia by the surgical team experienced in pancreatic surgery. Results: Total 496 patients were admitted to the surgery department with the diagnosis of acute pancreatitis or with complications of acute pancreatitis. Among them, 80 patients had local complications due to acute pancreatitis. All patients were managed using the step-up approach, starting with conservative management and minimally invasive intervention when warranted. 24 patients required surgical intervention due to failure of endoscopic or radiological intervention or positions of lesions being inaccessible to these techniques. Among the 24 patients in the study, 4 patients had PPC, all of whom were managed with external drainage due to persistent symptoms. 6 patients who had ANC were initially subjected to conservative management. In addition, WON was noted in 4 patients and 10 patients had pseudocyst. Due to clinical deterioration and high suspicion of infected necrosis in patients with WON, FNAC was performed in all patients, revealing growth in culture. Conclusion: Patients who have local complications of pancreatitis respond best to treatment at a tertiary care centre that is staffed with pancreatic surgeons. Surgery is still the primary treatment option for pancreatic necrosis and pancreatic fluid collection, despite the proliferation of endoscopic procedures designed to treat these conditions.