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Complications of Percutaneous Drainage in Step-Up Approach for Management of Pancreatic Necrosis: Experience of 10 Years from a Tertiary Care Center

  • 2019 SSAT Plenary Presentation
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Percutaneous catheter drainage (PCD) as initial intervention in necrotizing pancreatitis has led to improved outcomes and obviated need for surgery in a significant proportion. However, there can be difficulty in accessing deep-seated necrotic collections by percutaneous catheter and complications are likely.

Methods

The present study involves a retrospective analysis of a prospectively maintained database of patients with necrotizing pancreatitis managed by a step-up approach. All patients who underwent PCD were studied for catheter-related complications.

Results

A total of 707 PCD catheters were used in 314 patients (median 2, interquartile range IQR 1–3). The total number of interventions were 1194 (median 3, IQR 2–5). Enteric communication was seen in 8.9%, of which colonic fistula occurred in 71.4%, duodenal in 17.8%, and jejunal in 10.7% of patients. Majority (78.5%) of the fistulae were managed conservatively by withdrawal of the drain. Operative management was required in 30% of colonic and 40% of duodenal fistulae. Need for surgery, length of hospital stay, and mortality were not significantly different between patients with and without fistulae. Bleeding complications were seen in 7.3% of patients, out of which 34.7% were managed conservatively, 21.7% required angioembolization of pseudo-aneurysms, and 34.7% needed surgery. Patients with bleeding had significantly higher requirement for surgery and mechanical ventilation compared to those with no bleeding. There was no significant increase in hospital stay, ICU stay, and mortality.

Conclusion

Hollow viscus and vascular injuries are important complications seen with catheter drainage of necrotic collections. Majority of patients with enteric communication were managed conservatively, with no added morbidity or mortality. Bleeding complications related to PCD had higher requirement for surgical intervention, but mortality rates remained similar to those of patients with no bleeding complications.

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Authors and Affiliations

  1. Division of Surgical Gastroenterology, Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Rajesh Gupta, Aditya Kulkarni, Raghavendra Babu, Sunil Shenvi, Rahul Gupta & Gopal Sharma

  2. Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Mandeep Kang & Ujjwal Gorsi

  3. Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India

    Surinder Singh Rana

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  1. Rajesh Gupta
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All of the authors were involved in the formation of the study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis; and administrative, technical, or material support.

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Gupta, R., Kulkarni, A., Babu, R. et al. Complications of Percutaneous Drainage in Step-Up Approach for Management of Pancreatic Necrosis: Experience of 10 Years from a Tertiary Care Center. J Gastrointest Surg 24, 598–609 (2020). https://doi.org/10.1007/s11605-019-04470-z

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