Abstract
In 15%t of patients of patients developing acute pancreatitis, the disease progresses to a severe necrotising pancreatic/peri-pancreatic process accompanied by a systemic inflammatory response resulting in a life-threatening disorder with a reported mortality exceeding 20 %. Bacterial infection of pancreatic necrosis is the most frequent local complication and is responsible for the majority of deaths from organ failure. The treatment is by pancreatic necrosectomy. Although traditionally performed by laparotomy, in the last few decades, minimal access and radiologically-guided approaches have been used increasingly with published reports which collectively indicate reduced morbidity (bleeding and intestinal injuries) and improved survival. The author’s experience is with the operation of infracolic pancreatic necrosectomy followed by continuous irrigation and drainage of the lesser sac with the Beger’s technique.
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References
Isenmann R, Rau B, Beger HG. Early severe acute pancreatitis: characteristics of a new subgroup. Pancreas. 2001;22(3):274–8.
Gloor B, Muller CA, Worni M, Martignoni ME, Uhl W, Buchler MW. Late mortality in patients with severe acute pancreatitis. Br J Surg. 2001;88(7):975–9.
Raty S, Sand J, Nordback I. Difference in microbes contaminating pancreatic necrosis in biliary and alcoholic pancreatitis. Int J Pancreatol. 1998;24(3):187–91.
Buchler MW, Gloor B, Muller CA, Friess H, Seiler CA, Uhl W. Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg. 2000;232(5):627–9.
Gotzinger P, Wamser P, Barlan M, Sautner T, Jakesz R, Fugger R. Candida infection of local necrosis in severe acute pancreatitis is associated with increased mortality. Shock. 2000;14(3):320–3.
Juvonen PO, Alhava EM, Takala JA. Gut permeability in patients with acute pancreatitis. Scand J Gastroenterol. 2000;35(12):1314–8.
Nordback I, Sand J, Saaristo R, Paajanen H. Early treatment with antibiotics reduces the need for surgery in acute necrotizing pancreatitis--a single-center randomized study. J Gastrointest Surg. 2001;5(2):113–8.
Slavin J, Neoptolemos JP. Antibiotic prophylaxis in severe acute pancreatitis--what are the facts? Langenbecks Arch Surg. 2001;386(2):155–9.
Gloor B, Schmidt O, Uhl W, Buchler MW. Prophylactic antibiotics and pancreatic necrosis. Curr Gastroenterol Rep. 2001;3(2):109–14.
Shrikhande S, Friess H, Issenegger C, Martignoni ME, Yong H, Gloor B, Yeates R, Kleeff J, Buchler MW. Fluconazole penetration into the pancreas. Antimicrob Agents Chemother. 2000;44(9):2569–71.
Villatoro E, Bassi C, Larvin M. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Cochrane Rev. Prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library. 2009; Issue 1. http://www.thecochranelibrary.com.
Matsukawa H, Hara A, Ito T, Fukui K, Sato K, Ichikawa M, Yoshioka M, Seki H, Takeda K, Sunamura M, Shibuya K, Kobari M, Matsuno S. Role of early continuous regional arterial infusion of protease inhibitor and antibiotic in nonsurgical treatment of acute necrotizing pancreatitis. Digestion. 1999;60 Suppl 1:9–13.
Takeda K, Matsuno S, Ogawa M, Watanabe S, Atomi Y. Continuous regional arterial infusion (CRAI) therapy reduces the mortality rate of acute necrotizing pancreatitis: results of a cooperative survey in Japan. J Hepatobiliary Pancreat Surg. 2001;8(3):216–20.
Isaji S, Takada T, Kawarada Y, et al. JPN Guidelines for the management of acute pancreatitis: surgical management. J Hepatobiliary Pancreat Surg. 2006;13(1):48–55. doi:10.1007/s00534-005-1051-7. PMCID: PMC2779397.
Lankisch PG, Struckmann K, Assmus C, Lehnick D, Maisonneuve P, Lowenfels AB. Do we need a computed tomography examination in all patients with acute pancreatitis within 72 h after admission to hospital for the detection of pancreatic necrosis? Scand J Gastroenterol. 2001;36(4):432–6.
Beger HG, Rau B, Isenmann R. Necrosectomy or anatomically guided resection in acute pancreatitis. Chirurg. 2000;71(3):274–80.
Nakasaki H, Tajima T, Fujii K, Makuuchi H. A surgical treatment of infected pancreatic necrosis: retroperitoneal laparotomy. Dig Surg. 1999;16:506–11. doi:10.1159/000018777.
Wyncoll DL. The management of severe acute necrotising pancreatitis: an evidence-based on review of the literature. Intensive Care Med. 1999;25(2):146–56.
Gouzi JL, Bloom E, Julio C, Labbe F, Sans N, el Rassi Z, Carrere N, Pradere B. Percutaneous drainage of infected pancreatic necrosis: an alternative to Surgery. Chirurgie. 1999;124(1):31–7.
Carter CR, McKay CJ, Imrie CW. Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pancreatic necrosis: an initial experience. Ann Surg. 2000;232(2):175–80.
Kam A, Young N, Markson G, Wong KP, Brancatisano R. Case report: inappropriate use of percutaneous drainage in the management of pancreatic necrosis. Gastroenterol Hepatol. 1999;14(7):699–704.
Oria A, Ocampo C, Zandalazini H, Chiappetta L, Moran C. Internal drainage of giant acute pseudocysts: the role of video-assisted pancreatic necrosectomy. Arch Surg. 2000;135(2):136–40.
Horvath KD, Kao LS, Wherry KL, Pellegrini CA, Sinanan MN. A technique for laparoscopic-assisted percutaneous drainage of infected pancreatic necrosis and pancreatic abscess. Surg Endosc. 2001;15(10):1221–5.
Castellanos G, Serrano A, Pinero A, Bru M, Parraga M, Marin P, Parrilla P. Retroperitoneoscopy in the management of drained infected pancreatic necrosis. Gastrointest Endosc. 2001;53(4):514–5.
Cuschieri SA, Jakimowicz JJ, Stultiens G. Laparoscopic infracolic approach for complications of acute pancreatitis. Semin Laparosc Surg. 1998;5(3):189–94.
Hamad GG, Broderick TJ. Laparoscopic pancreatic necrosectomy. J Laparoendosc Adv Surg Tech A. 2000;10(2):115–8.
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Cuschieri, A. (2017). Treatment of Severe Complicated Pancreatitis. In: Bonjer, H. (eds) Surgical Principles of Minimally Invasive Procedures. Springer, Cham. https://doi.org/10.1007/978-3-319-43196-3_24
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DOI: https://doi.org/10.1007/978-3-319-43196-3_24
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