Abstract
Background: Minimally invasive necrosectomy is associated with better outcomes and certain technical limits. The study aimed to evaluate a 12-year-long experience with lumbo-retroperitoneal/subcostal necrosectomy.
Methods: Patients with different forms of necrotizing pancreatitis were prospectively included in the study from 2004 to 2016. Patients who underwent ultrasound-assisted limited lumbo-retroperitoneal and/or subcostal necrosectomy were allocated to focused open necrozectomy (FON) group; those who underwent conventional open necrosectomy (CON) served for control. Sepsis was defined according to Sepsis-3 guidelines.
Results: A total of 182 patients underwent necrosectomy; 84 according to the FON and 98 –according to the CON approach. In 19% of patients the disease resulted in >30% pancreatic necrosis; in 34% it was graded at 30–50%, and 47% showed >50% necrosis. Sepsis developed in 77% –80% of patients. The median length of intervention was 58 minutes in FON vs. 116 minutes in CON group, p<0.001. Notably fewer repeated interventions in the walled-off necrosis phase were in FON group, 33% vs. 63%, p<0.003. The overall complication rate was similar, 18%–34%. The median ICU stay and hospital stay were significantly shorter in FON group, 12 days vs. 21 days, p<0.001, and 50 days vs. 69 days, p< 0.002. Mortality reached 6% in FON group and 9% in CON group.
Conclusion: Lumbo-retroperitoneal and subcostal necrosectomy are associated with low complication and mortality rates.
Methods: Patients with different forms of necrotizing pancreatitis were prospectively included in the study from 2004 to 2016. Patients who underwent ultrasound-assisted limited lumbo-retroperitoneal and/or subcostal necrosectomy were allocated to focused open necrozectomy (FON) group; those who underwent conventional open necrosectomy (CON) served for control. Sepsis was defined according to Sepsis-3 guidelines.
Results: A total of 182 patients underwent necrosectomy; 84 according to the FON and 98 –according to the CON approach. In 19% of patients the disease resulted in >30% pancreatic necrosis; in 34% it was graded at 30–50%, and 47% showed >50% necrosis. Sepsis developed in 77% –80% of patients. The median length of intervention was 58 minutes in FON vs. 116 minutes in CON group, p<0.001. Notably fewer repeated interventions in the walled-off necrosis phase were in FON group, 33% vs. 63%, p<0.003. The overall complication rate was similar, 18%–34%. The median ICU stay and hospital stay were significantly shorter in FON group, 12 days vs. 21 days, p<0.001, and 50 days vs. 69 days, p< 0.002. Mortality reached 6% in FON group and 9% in CON group.
Conclusion: Lumbo-retroperitoneal and subcostal necrosectomy are associated with low complication and mortality rates.
| Original language | English |
|---|---|
| Article number | P56.03 |
| Pages (from-to) | S710-S711 |
| Number of pages | 2 |
| Journal | HPB |
| Volume | 21 |
| Issue number | Suppl.3 |
| DOIs | |
| Publication status | Published - 2019 |
| Externally published | Yes |
| Event | 12th Biennial Congress of the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) - Mainz, Germany Duration: 23 May 2017 → 26 May 2017 Conference number: 12 https://www.ihpba.org/includes/moxiemanager/data/files/E-AHPBA_Congress_2017_Mainz_Save-the-Date_Flyer.pdf |
Keywords*
- Lumbo-Retroperitoneal and Subcostal Approach is Associated with Low Complication Rate and Mortality in Different Types of Necrotizing Pancreatitis
Field of Science*
- 3.2 Clinical medicine
Publication Type*
- 3.4. Other publications in conference proceedings (including local)