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

Autor:	Timmerhuis HC; From the Department of Surgery, Stanford University School of Medicine, Stanford CA., Ngongoni RF; From the Department of Surgery, Stanford University School of Medicine, Stanford CA., Li A; From the Department of Surgery, Stanford University School of Medicine, Stanford CA., McGuire SP; Departments of Surgery and Division of Gastroenterology, Indiana University School of Medicine and Indiana University Health, Indianapolis, IN., Lewellen KA; Departments of Surgery and Division of Gastroenterology, Indiana University School of Medicine and Indiana University Health, Indianapolis, IN., Dua MM; From the Department of Surgery, Stanford University School of Medicine, Stanford CA., Chughtai K; Department of Radiology, Stanford University School of Medicine, Stanford, CA., Zyromski NJ; Departments of Surgery and Division of Gastroenterology, Indiana University School of Medicine and Indiana University Health, Indianapolis, IN., Visser BC; From the Department of Surgery, Stanford University School of Medicine, Stanford CA.
Jazyk:	angličtina
Zdroj:	Pancreas [Pancreas] 2024 Aug 01; Vol. 53 (7), pp. e573-e578.
DOI:	10.1097/MPA.0000000000002334
Abstrakt:	Objective: Surgical 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 Methods: This 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. Results: Forty-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). Conclusions: STGN 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. Competing Interests: The authors declare no conflict of interest. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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