The Potential Clinical Benefits of Direct Surgical Transgastric Pancreatic Necrosectomy for Patients With Infected Necrotizing Pancreatitis

被引：0

作者：

Timmerhuis, Hester C. ^{[1
]}

Ngongoni, Rejoice F. ^{[1
]}

Li, Amy ^{[1
]}

McGuire, Sean P. ^{[2
,3
,4
]}

Lewellen, Kyle A. ^{[2
,3
,4
]}

Dua, Monica M. ^{[1
]}

Chughtai, Komal ^{[5
]}

Zyromski, Nicholas J. ^{[2
,3
,4
]}

Visser, Brendan C. ^{[1
]}

机构：

[1] Stanford Univ, Sch Med, Dept Surg, Stanford, CA 94305 USA

[2] Indiana Univ Sch Med, Dept Surg, Indianapolis, IN USA

[3] Indiana Univ Sch Med, Div Gastroenterol, Indianapolis, IN USA

[4] Indiana Univ Hlth, Indianapolis, IN USA

[5] Stanford Univ, Sch Med, Dept Radiol, Stanford, CA 94305 USA

来源：

PANCREAS | 2024年 / 53卷 / 07期

关键词：

necrotizing pancreatitis; infected necrosis; intervention; laparoscopic transgastric pancreatic necrosectomy; CTSI = computed tomography severity index; ICU = intensive care unit; IQR = interquartile range; IR = interventional radiology; SD = standard deviation; STGN = surgical transgastric pancreatic necrosectomy; STEP-UP APPROACH; ENDOSCOPIC NECROSECTOMY; CATHETER DRAINAGE; FLUID COLLECTIONS; MANAGEMENT; EFFICACY; NECROSIS; MULTICENTER; CT; DEBRIDEMENT;

D O I：

10.1097/MPA.0000000000002334

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

ObjectiveSurgical transgastric pancreatic necrosectomy (STGN) has the potential to overcome the shortcomings (ie, repeat interventions, prolonged hospitalization) of the step-up approach for infected necrotizing pancreatitis. We aimed to determine the outcomes of STGN for infected necrotizing pancreatitis.Materials and MethodsThis observational cohort study included adult patients who underwent STGN for infected necrosis at two centers from 2008 to 2022. Patients with a procedure for pancreatic necrosis before STGN were excluded. Primary outcomes included mortality, length of hospital and intensive care unit (ICU) stay, new-onset organ failure, repeat interventions, pancreatic fistulas, readmissions, and time to episode closure.ResultsForty-three patients underwent STGN at a median of 48 days (interquartile range [IQR] 32-70) after disease onset. Mortality rate was 7% (n = 3). After STGN, the median length of hospital was 8 days (IQR 6-17), 23 patients (53.5%) required ICU admission (2 days [IQR 1-7]), and new-onset organ failure occurred in 8 patients (18.6%). Three patients (7%) required a reintervention, 1 (2.3%) developed a pancreatic fistula, and 11 (25.6%) were readmitted. The median time to episode closure was 11 days (IQR 6-22).ConclusionsSTGN allows for treatment of retrogastric infected necrosis in one procedure and with rapid episode resolution. With these advantages and few pancreatic fistulas, direct STGN challenges the step-up approach.

引用

页码：e573 / e578

页数：6

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