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The effect of a novel minimally invasive strategy for infected necrotizing pancreatitis

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Abstract

Background

Step-up approach consisting of multiple minimally invasive techniques has gradually become the mainstream for managing infected pancreatic necrosis (IPN). In the present study, we aimed to compare the safety and efficacy of a novel four-step approach and the conventional approach in managing IPN.

Methods

According to the treatment strategy, consecutive patients fulfilling the inclusion criteria were put into two time intervals to conduct a before-and-after comparison: the conventional group (2010–2011) and the novel four-step group (2012–2013). The conventional group was essentially open necrosectomy for any patient who failed percutaneous drainage of infected necrosis. And the novel drainage approach consisted of four different steps including percutaneous drainage, negative pressure irrigation, endoscopic necrosectomy and open necrosectomy in sequence. The primary endpoint was major complications (new-onset organ failure, sepsis or local complications, etc.). Secondary endpoints included mortality during hospitalization, need of emergency surgery, duration of organ failure and sepsis, etc.

Results

Of the 229 recruited patients, 92 were treated with the conventional approach and the remaining 137 were managed with the novel four-step approach. New-onset major complications occurred in 72 patients (78.3%) in the two-step group and 75 patients (54.7%) in the four-step group (p < 0.001). For other important endpoints, although there was no statistical difference in mortality between the two groups (p = 0.403), significantly fewer patients in the four-step group required emergency surgery when compared with the conventional group [14.6% (20/137) vs. 45.6% (42/92), p < 0.001]. In addition, stratified analysis revealed that the four-step approach group presented significantly lower incidence of new-onset organ failure and other major complications in patients with the most severe type of AP.

Conclusion

Comparing with the conventional approach, the novel four-step approach significantly reduced the rate of new-onset major complications and requirement of emergency operations in treating IPN, especially in those with the most severe type of acute pancreatitis.

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Acknowledgement

We would like to show our deepest gratitude to Dr. Jie Dong and Qi Yang for their assistance in statistic analysis.

Funding

This study was supported by the National Science Foundation of China (81170438 and 81200334).

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Author notes

  1. Zhihui Tong and Xiao Shen have contributed equally to this work.

Authors and Affiliations

  1. Surgical Intensive Care Unit (SICU), Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Jinling Hospital, No. 305 East Zhongshan Road, Nanjing, 210002, People’s Republic of China

    Zhihui Tong, Xiao Shen, Lu Ke, Gang Li, Jing Zhou, Yiyuan Pan, Baiqiang Li, Dongliang Yang, Weiqin Li & Jieshou Li

  2. Intensive Care Unit (ICU), Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, People’s Republic of China

    Xiao Shen

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  1. Zhihui Tong
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Correspondence to Lu Ke or Weiqin Li.

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Dr. Zhihui Tong, Xiao Shen, Lu Ke, Gang Li, Jing Zhou, Yiyuan Pan, Baiqiang Li, Dongliang Yang, Weiqin Li and Jieshou Li have no conflicts of interest or financial ties to disclose.

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Tong, Z., Shen, X., Ke, L. et al. The effect of a novel minimally invasive strategy for infected necrotizing pancreatitis. Surg Endosc 31, 4603–4616 (2017). https://doi.org/10.1007/s00464-017-5522-0

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