Abstract
Despite that pancreatic necrosis complicates only 15 % of cases of acute pancreatitis (AP), it is associated with high morbidity and considerable mortality. In an attempt to improve prognosis, many surgical strategies have been described during the last few decades. Currently, necrosectomy remains the cornerstone in the surgical treatment of infected pancreatic necrosis and in selected cases of sterile necrotizing pancreatitis. Following necrosectomy, continuous closed lavage is recommended by many authors, while closed abdominal packing /drainage and repeated planned necrosectomies- commonly using the zipper technique-are also acceptable alternative strategies. Open abdomen (laparostomy) is rarely indicated in carefully selected cases (typically in abdominal compartment syndrome associated with necrotizing AP). During the last decade, minimally invasive techniques (including percutaneous drainage, retroperitoneal endoscopic approach, transgastric endoscopic approach etc) have been extensively studied by some groups not only in the management of pancreatic abscesses and / or pseudocysts, but also as primary methods of treatment of necrotizing AP. Results have been impressive, but experience currently is limited to only a few centers around the world.
Keywords: Pancreatitis, surgery, necrosectomy, laparoscopic, endoscopic, pancreas, lavage
Infectious Disorders - Drug Targets
Title:Necrotizing Acute Pancreatitis Current Status - Emerging New Strategies in Surgical Management
Volume: 12 Issue: 2
Author(s): George H. Sakorafas, Dimitrios Sampanis, Christos Lappas, Panayiotis Kokoropoulos, Aikaterini Mastoraki and Vassilios Smyrniotis
Affiliation:
Keywords: Pancreatitis, surgery, necrosectomy, laparoscopic, endoscopic, pancreas, lavage
Abstract: Despite that pancreatic necrosis complicates only 15 % of cases of acute pancreatitis (AP), it is associated with high morbidity and considerable mortality. In an attempt to improve prognosis, many surgical strategies have been described during the last few decades. Currently, necrosectomy remains the cornerstone in the surgical treatment of infected pancreatic necrosis and in selected cases of sterile necrotizing pancreatitis. Following necrosectomy, continuous closed lavage is recommended by many authors, while closed abdominal packing /drainage and repeated planned necrosectomies- commonly using the zipper technique-are also acceptable alternative strategies. Open abdomen (laparostomy) is rarely indicated in carefully selected cases (typically in abdominal compartment syndrome associated with necrotizing AP). During the last decade, minimally invasive techniques (including percutaneous drainage, retroperitoneal endoscopic approach, transgastric endoscopic approach etc) have been extensively studied by some groups not only in the management of pancreatic abscesses and / or pseudocysts, but also as primary methods of treatment of necrotizing AP. Results have been impressive, but experience currently is limited to only a few centers around the world.
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Cite this article as:
H. Sakorafas George, Sampanis Dimitrios, Lappas Christos, Kokoropoulos Panayiotis, Mastoraki Aikaterini and Smyrniotis Vassilios, Necrotizing Acute Pancreatitis Current Status - Emerging New Strategies in Surgical Management, Infectious Disorders - Drug Targets 2012; 12 (2) . https://dx.doi.org/10.2174/187152612800100107
DOI https://dx.doi.org/10.2174/187152612800100107 |
Print ISSN 1871-5265 |
Publisher Name Bentham Science Publisher |
Online ISSN 2212-3989 |
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