Abstract
Necrotizing pancreatitis is an uncommon yet serious complication of acute pancreatitis with mortality rates reported up to 15% that reach 30% in case of infection. Traditionally open surgical debridement was the only tool in our disposal to manage this serious clinical entity. This approach is however associated with poor outcomes. Management has now shifted away from open surgical debridement to a more conservative management and minimally invasive approaches. Contemporary approach to patients with necrotizing pancreatitis and/or infectious pancreatitis is summarized in the 3Ds: Delay, Drain and Debride. Patients can be managed in the intensive care unit and any intervention should be delayed. Percutaneous drainage can be utilized first and early in the course of the disease, followed by endoscopic drainage or video assisted retroperitoneoscopic drainage if necrosectomy is deemed necessary. Open surgery is now less frequently performed and should be reserved for cases refractory to any other approach. The management of necrotizing pancreatitis therefore requires a multidisciplinary dynamic model of approach rather than being a surgical disease.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 16106-16112 |
| Number of pages | 7 |
| Journal | World Journal of Gastroenterology |
| Volume | 20 |
| Issue number | 43 |
| DOIs | |
| State | Published - Nov 21 2014 |
| Externally published | Yes |
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Keywords
- Debridement
- Endoscopic necrosectomy
- Infected necrosis
- Necrosectomy
- Necrotizing pancreatitis
- Percutaneous catheter drainage
- Severe acute pancreatitis
- Video- Assisted retroperitoneal debridement
ASJC Scopus subject areas
- Gastroenterology
- Medicine(all)
Cite this
Surgical management of necrotizing pancreatitis : An overview. / Kokosis, George; Perez, Alexander; Pappas, Theodore N.
In: World Journal of Gastroenterology, Vol. 20, No. 43, 21.11.2014, p. 16106-16112.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - Surgical management of necrotizing pancreatitis
T2 - An overview
AU - Kokosis, George
AU - Perez, Alexander
AU - Pappas, Theodore N.
PY - 2014/11/21
Y1 - 2014/11/21
N2 - Necrotizing pancreatitis is an uncommon yet serious complication of acute pancreatitis with mortality rates reported up to 15% that reach 30% in case of infection. Traditionally open surgical debridement was the only tool in our disposal to manage this serious clinical entity. This approach is however associated with poor outcomes. Management has now shifted away from open surgical debridement to a more conservative management and minimally invasive approaches. Contemporary approach to patients with necrotizing pancreatitis and/or infectious pancreatitis is summarized in the 3Ds: Delay, Drain and Debride. Patients can be managed in the intensive care unit and any intervention should be delayed. Percutaneous drainage can be utilized first and early in the course of the disease, followed by endoscopic drainage or video assisted retroperitoneoscopic drainage if necrosectomy is deemed necessary. Open surgery is now less frequently performed and should be reserved for cases refractory to any other approach. The management of necrotizing pancreatitis therefore requires a multidisciplinary dynamic model of approach rather than being a surgical disease.
AB - Necrotizing pancreatitis is an uncommon yet serious complication of acute pancreatitis with mortality rates reported up to 15% that reach 30% in case of infection. Traditionally open surgical debridement was the only tool in our disposal to manage this serious clinical entity. This approach is however associated with poor outcomes. Management has now shifted away from open surgical debridement to a more conservative management and minimally invasive approaches. Contemporary approach to patients with necrotizing pancreatitis and/or infectious pancreatitis is summarized in the 3Ds: Delay, Drain and Debride. Patients can be managed in the intensive care unit and any intervention should be delayed. Percutaneous drainage can be utilized first and early in the course of the disease, followed by endoscopic drainage or video assisted retroperitoneoscopic drainage if necrosectomy is deemed necessary. Open surgery is now less frequently performed and should be reserved for cases refractory to any other approach. The management of necrotizing pancreatitis therefore requires a multidisciplinary dynamic model of approach rather than being a surgical disease.
KW - Debridement
KW - Endoscopic necrosectomy
KW - Infected necrosis
KW - Necrosectomy
KW - Necrotizing pancreatitis
KW - Percutaneous catheter drainage
KW - Severe acute pancreatitis
KW - Video- Assisted retroperitoneal debridement
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UR - http://www.scopus.com/inward/citedby.url?scp=84912571882&partnerID=8YFLogxK
U2 - 10.3748/wjg.v20.i43.16106
DO - 10.3748/wjg.v20.i43.16106
M3 - Review article
VL - 20
SP - 16106
EP - 16112
JO - World Journal of Gastroenterology
JF - World Journal of Gastroenterology
SN - 1007-9327
IS - 43
ER -