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EFFICACY OF PROACTIVE APPLICATION OF COMBINED RETROPERITONEAL-ENDOSCOPIC-TRANSCUTANEOUS APPROACH IN PATIENTS WITH INFECTED ACUTE NECROTIZING PANCREATITIS
Igor Khomiak*1, Oleksandr Rotar2, Ivan Tereshkevych1, Vasyl I. Rotar2, Andrii Khomiak1
1Department of Pancreas Surgery and Bile Ducts Reconstruction Surgery, A.A. Shalimov National Institute of Surgery and Transplantology, Kyiv, Ukraine; 2General Surgery, Bukovinian State Medical University, Chernivtsi, Ukraine
Background. The surgical management of acute necrotizing pancreatitis (ANP) has evolved from open surgical debridement to percutaneous, endoscopic and minimally invasive retroperitoneal approaches. Their combination could further improve results of treatment especially in case of large necrotic collections.
Aim. To estimate efficacy of proactive application of combined retroperitoneal-endoscopic-transcutaneous (RET) approach in surgical treatment of infected ANP.
Material and methods. We performed cohort observational clinical study of 28 patients with infected pathological foci of ANP in whom RET approach was applied. Control group (CG) consisted of 85 patients with transcutaneous ultrasound-guided interventions. In both group we applied proactive strategy, which consisted of frequent and early drain revision and upsizing of drains in case of lack of clinical improvement. Mortality, morbidity, necessity of open necrosectomy, length of in-hospital treatment and amount of invasive procedures were studied.
Results. There were no procedure-related complications in RET group. Open necrosectomy was necessary in 1 (3.6%) patient, in 9 cases we applied video-assisted retroperitoneal debridement (VARD). In CG ultrasound-guided drainage was performed in 41 (43.5%) patients, VARD - in 6 cases, mini-laparotomic necrosectomy - in 5 cases, open necrosectomy - in 23 (25.9%, p<0.05) cases. In-hospital duration of treatment was 28±2 days in CG patients and 22±2 - in RET group (p>0.05). There was no mortality in RET group, in CG it reached 1.08% (p>0.05). Hemorrhages from pseudoaneurism occurred in 3 patients from CG, pancreatic fistulas appeared in 8 cases whereas there were no such complications in RET patients (p=0.095).
Conclusion. Proactive application of retroperitoneal-endoscopic-transcutaneous approach decreases necessity of open necrosectomy as well as frequency of complications.
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