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World Journal of Surgery

, Volume 43, Issue 12, pp 2994–3002 | Cite as

Multidisciplinary Approach to Treating Severe Acute Pancreatitis in a Low-Volume Hospital

  • Alvaro Robin-LersundiEmail author
  • Ana Abella Alvarez
  • Carlos San Miguel Mendez
  • Almudena Moreno Elalo-Olaso
  • Arturo Cruz Cidoncha
  • Asunción Aguilera Velardo
  • Federico Gordo Vidal
  • Miguel-Angel García-Ureña
Original Scientific Report

Abstract

Background

Up to 25% of patients with acute pancreatitis develop severe complications and are classified as severe pancreatitis with a high death rate. To improve outcomes, patients may require interventional measures including surgical procedures. Multidisciplinary approach and best practice guidelines are important to decrease mortality.

Methods

We have conducted a retrospective analysis from a prospectively maintained database in a low-volume hospital. A total of 1075 patients were attended for acute pancreatitis over a ten-year period. We have analysed 44 patients meeting the criteria for severe acute pancreatitis and for intensive care unit (ICU) admittance. Demographics and clinical data were analysed. Patients were treated according to international guidelines and a multidisciplinary flowchart for acute pancreatitis and a step-up approach for pancreatic necrosis.

Results

Forty-four patients were admitted to the ICU due to severe acute pancreatitis. Twenty-five patients needed percutaneous drainage of peri-pancreatic or abdominal fluid collections or cholecystitis. Eight patients underwent endoscopic retrograde cholangiopancreatography for choledocholithiasis and biliary sepsis or pancreatic leakage, and one patient received endoscopic trans-gastric endoscopic prosthesis for pancreatic necrosis. Sixteen patients underwent surgery: six patients for septic abdomen, four patients for pancreatic necrosis and two patients due to abdominal compartment syndrome. Four patients had a combination of surgical procedures for pancreatic necrosis and for abdominal compartment syndrome. Overall mortality was 9.1%.

Conclusion

Severe acute pancreatitis represents a complex pathology that requires a multidisciplinary approach. Establishing best practice treatments and evidence-based guidelines for severe acute pancreatitis may improve outcomes in low-volume hospitals.

Notes

Funding

This study has not received grant support.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Alvaro Robin-Lersundi
    • 1
    Email author
  • Ana Abella Alvarez
    • 2
  • Carlos San Miguel Mendez
    • 1
  • Almudena Moreno Elalo-Olaso
    • 1
  • Arturo Cruz Cidoncha
    • 1
  • Asunción Aguilera Velardo
    • 1
  • Federico Gordo Vidal
    • 2
    • 3
  • Miguel-Angel García-Ureña
    • 1
    • 4
  1. 1.Department of SurgeryHospital Universitario del HenaresCosladaSpain
  2. 2.Department of Intensive Care MedicineHospital Universitario del HenaresCosladaSpain
  3. 3.Grupo de Investigación en Patología CríticaUniversidad Francisco de VitoriaPozuelo de AlarcónSpain
  4. 4.Grupo de Investigación en Pared AbdominalUniversidad Francisco de VitoriaPozuelo de AlarcónSpain

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