Minimal-access retroperitoneal pancreatic necrosectomy for infected necrotizing pancreatitis: a multicentre study of a step-up approach
Abstract Background Various minimally invasive approaches have been described for infected necrotizing pancreatitis. This article describes a modified minimal-access retroperitoneal pancreatic necrosectomy (MARPN) procedure assisted by gas insufflation. Methods This retrospective, observational stud...
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| Veröffentlicht in: | British journal of surgery 2020-09, Vol.107 (10), p.1344-1353 |
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| creator | Liu, Z-W Yang, S-Z Wang, P-F Feng, J He, L Du, J-D Xiao, Y-Y Jiao, H-B Zhou, F-H Song, Q Zhou, M-T Xin, X-L Chen, J-Y Ren, W-Z Lu, S-C Cai, S-W Dong, J-H |
| description | Abstract
Background
Various minimally invasive approaches have been described for infected necrotizing pancreatitis. This article describes a modified minimal-access retroperitoneal pancreatic necrosectomy (MARPN) procedure assisted by gas insufflation.
Methods
This retrospective, observational study documented patients who had undergone a step-up MARPN between 1 January 2010 and 31 December 2016. A minimum follow-up of 1 year was required for inclusion. The step-up approach involved percutaneous catheter drainage followed by the modified MARPN and necrosectomy. If more than one access site was needed it was categorized as complex MARPN.
Results
Of 212 patients with infected necrotizing pancreatitis, 164 (77·4 per cent) underwent a step-up approach. The median number of percutaneous catheter drains and MARPN procedures was 3 (range 1–7) and 1 (1–6) respectively. Ninety patients (54·9 per cent) underwent complex MARPN. For residual necrosis after MARPN, three patients (1·8 per cent) underwent sinus tract gastroscopy, and 11 (6·7 per cent) had sinography combined with a tube change. However, operations in 13 patients (7·9 per cent) required conversion to open surgery. Postoperative complications developed in 103 patients (62·8 per cent). The mortality rate was 6·1 per cent (10 deaths).
Conclusion
A step-up approach using a modified MARPN for infected necrotizing pancreatitis is a reasonable option.
Graphical Abstract
Minimally invasive approaches have been used increasingly in the management of infected necrotizing pancreatitis. This study presents a modified minimal-access retroperitoneal pancreatic necrosectomy procedure assisted by carbon dioxide insufflation, instead of saline. A clear field of view without necrotic debris floating in saline makes the technique safe and efficient.
Graphical Abstract
High degree of successVIDEO
Presented in part to the Joint Congress of the Sixth Biennial Congress of the Asian–Pacific Hepato-Pancreato-Biliary Association and the 29th Meeting of the Japanese Society of Hepato-Biliary-Pancreatic Surgery, Yokohama, Japan, June 2017 |
| doi_str_mv | 10.1002/bjs.11619 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_proquest_miscellaneous_2406579781</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1002/bjs.11619</oup_id><sourcerecordid>2436417934</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3489-a1a6d835a4df45e5f9cc0d93155c2908ec58143e23ea297f44671492e74df46e3</originalsourceid><addsrcrecordid>eNp1kU1PFTEUhhujkQu44A-YJrpwM9DTj5kpOyWiEggLcD0pnTPYm5l2bDsx1z_g36ZwURMSVv04z3PanJeQA2CHwBg_ulmnQ4Aa9AuyAlGrikPdviQrxlhTgeBih-ymtGYMBFP8NdkRXEoNSq7Inwvn3WTGyliLKdGIOYYZo8vBoxnpbLyNaLKz1KONIaHNYdrQIUTq_FBO2G8r2f12_va_kF06poZOy1hk9DkiTXnpNzQM5TplnKtlpmaeYzD2xz55NZgx4ZvHdY98P_18ffK1Or_88u3k43llhWx1ZcDUfSuUkf0gFapBW8t6LUApyzVr0aoWpEAu0HDdDFLWDUjNsbkXahR75MO2b3n254Ipd5NLFsfReAxL6rhktWp000JB3z1B12GJvvyuUKKW0GghC_X2kVpuJuy7OZZxxk33d8QFONoCv9yIm391YN19dl3JrnvIrvt0dvWwKcb7rRGW-Xle3AGcdpkd</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2436417934</pqid></control><display><type>article</type><title>Minimal-access retroperitoneal pancreatic necrosectomy for infected necrotizing pancreatitis: a multicentre study of a step-up approach</title><source>Wiley Online Library - AutoHoldings Journals</source><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>Liu, Z-W ; Yang, S-Z ; Wang, P-F ; Feng, J ; He, L ; Du, J-D ; Xiao, Y-Y ; Jiao, H-B ; Zhou, F-H ; Song, Q ; Zhou, M-T ; Xin, X-L ; Chen, J-Y ; Ren, W-Z ; Lu, S-C ; Cai, S-W ; Dong, J-H</creator><creatorcontrib>Liu, Z-W ; Yang, S-Z ; Wang, P-F ; Feng, J ; He, L ; Du, J-D ; Xiao, Y-Y ; Jiao, H-B ; Zhou, F-H ; Song, Q ; Zhou, M-T ; Xin, X-L ; Chen, J-Y ; Ren, W-Z ; Lu, S-C ; Cai, S-W ; Dong, J-H</creatorcontrib><description>Abstract
Background
Various minimally invasive approaches have been described for infected necrotizing pancreatitis. This article describes a modified minimal-access retroperitoneal pancreatic necrosectomy (MARPN) procedure assisted by gas insufflation.
Methods
This retrospective, observational study documented patients who had undergone a step-up MARPN between 1 January 2010 and 31 December 2016. A minimum follow-up of 1 year was required for inclusion. The step-up approach involved percutaneous catheter drainage followed by the modified MARPN and necrosectomy. If more than one access site was needed it was categorized as complex MARPN.
Results
Of 212 patients with infected necrotizing pancreatitis, 164 (77·4 per cent) underwent a step-up approach. The median number of percutaneous catheter drains and MARPN procedures was 3 (range 1–7) and 1 (1–6) respectively. Ninety patients (54·9 per cent) underwent complex MARPN. For residual necrosis after MARPN, three patients (1·8 per cent) underwent sinus tract gastroscopy, and 11 (6·7 per cent) had sinography combined with a tube change. However, operations in 13 patients (7·9 per cent) required conversion to open surgery. Postoperative complications developed in 103 patients (62·8 per cent). The mortality rate was 6·1 per cent (10 deaths).
Conclusion
A step-up approach using a modified MARPN for infected necrotizing pancreatitis is a reasonable option.
Graphical Abstract
Minimally invasive approaches have been used increasingly in the management of infected necrotizing pancreatitis. This study presents a modified minimal-access retroperitoneal pancreatic necrosectomy procedure assisted by carbon dioxide insufflation, instead of saline. A clear field of view without necrotic debris floating in saline makes the technique safe and efficient.
Graphical Abstract
High degree of successVIDEO
Presented in part to the Joint Congress of the Sixth Biennial Congress of the Asian–Pacific Hepato-Pancreato-Biliary Association and the 29th Meeting of the Japanese Society of Hepato-Biliary-Pancreatic Surgery, Yokohama, Japan, June 2017</description><identifier>ISSN: 0007-1323</identifier><identifier>EISSN: 1365-2168</identifier><identifier>DOI: 10.1002/bjs.11619</identifier><identifier>PMID: 32449154</identifier><language>eng</language><publisher>Chichester, UK: Oxford University Press</publisher><subject>Adult ; Aged ; Aged, 80 and over ; Carbon Dioxide ; Catheters ; Conversion to Open Surgery ; Debridement - methods ; Drainage ; Female ; Humans ; Insufflation ; Laparoscopy - methods ; Male ; Middle Aged ; Pancreatitis ; Pancreatitis, Acute Necrotizing - surgery ; Postoperative Complications ; Retroperitoneal Space ; Retrospective Studies ; Saline Solution ; Therapeutic Irrigation ; Young Adult</subject><ispartof>British journal of surgery, 2020-09, Vol.107 (10), p.1344-1353</ispartof><rights>2020 BJS Society Ltd. Published by John Wiley & Sons, Ltd. 2020</rights><rights>2020 BJS Society Ltd Published by John Wiley & Sons Ltd</rights><rights>2020 BJS Society Ltd Published by John Wiley & Sons Ltd.</rights><rights>Copyright © 2020 BJS Society Ltd. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3489-a1a6d835a4df45e5f9cc0d93155c2908ec58143e23ea297f44671492e74df46e3</citedby><orcidid>0000-0002-3163-276X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fbjs.11619$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fbjs.11619$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32449154$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liu, Z-W</creatorcontrib><creatorcontrib>Yang, S-Z</creatorcontrib><creatorcontrib>Wang, P-F</creatorcontrib><creatorcontrib>Feng, J</creatorcontrib><creatorcontrib>He, L</creatorcontrib><creatorcontrib>Du, J-D</creatorcontrib><creatorcontrib>Xiao, Y-Y</creatorcontrib><creatorcontrib>Jiao, H-B</creatorcontrib><creatorcontrib>Zhou, F-H</creatorcontrib><creatorcontrib>Song, Q</creatorcontrib><creatorcontrib>Zhou, M-T</creatorcontrib><creatorcontrib>Xin, X-L</creatorcontrib><creatorcontrib>Chen, J-Y</creatorcontrib><creatorcontrib>Ren, W-Z</creatorcontrib><creatorcontrib>Lu, S-C</creatorcontrib><creatorcontrib>Cai, S-W</creatorcontrib><creatorcontrib>Dong, J-H</creatorcontrib><title>Minimal-access retroperitoneal pancreatic necrosectomy for infected necrotizing pancreatitis: a multicentre study of a step-up approach</title><title>British journal of surgery</title><addtitle>Br J Surg</addtitle><description>Abstract
Background
Various minimally invasive approaches have been described for infected necrotizing pancreatitis. This article describes a modified minimal-access retroperitoneal pancreatic necrosectomy (MARPN) procedure assisted by gas insufflation.
Methods
This retrospective, observational study documented patients who had undergone a step-up MARPN between 1 January 2010 and 31 December 2016. A minimum follow-up of 1 year was required for inclusion. The step-up approach involved percutaneous catheter drainage followed by the modified MARPN and necrosectomy. If more than one access site was needed it was categorized as complex MARPN.
Results
Of 212 patients with infected necrotizing pancreatitis, 164 (77·4 per cent) underwent a step-up approach. The median number of percutaneous catheter drains and MARPN procedures was 3 (range 1–7) and 1 (1–6) respectively. Ninety patients (54·9 per cent) underwent complex MARPN. For residual necrosis after MARPN, three patients (1·8 per cent) underwent sinus tract gastroscopy, and 11 (6·7 per cent) had sinography combined with a tube change. However, operations in 13 patients (7·9 per cent) required conversion to open surgery. Postoperative complications developed in 103 patients (62·8 per cent). The mortality rate was 6·1 per cent (10 deaths).
Conclusion
A step-up approach using a modified MARPN for infected necrotizing pancreatitis is a reasonable option.
Graphical Abstract
Minimally invasive approaches have been used increasingly in the management of infected necrotizing pancreatitis. This study presents a modified minimal-access retroperitoneal pancreatic necrosectomy procedure assisted by carbon dioxide insufflation, instead of saline. A clear field of view without necrotic debris floating in saline makes the technique safe and efficient.
Graphical Abstract
High degree of successVIDEO
Presented in part to the Joint Congress of the Sixth Biennial Congress of the Asian–Pacific Hepato-Pancreato-Biliary Association and the 29th Meeting of the Japanese Society of Hepato-Biliary-Pancreatic Surgery, Yokohama, Japan, June 2017</description><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Carbon Dioxide</subject><subject>Catheters</subject><subject>Conversion to Open Surgery</subject><subject>Debridement - methods</subject><subject>Drainage</subject><subject>Female</subject><subject>Humans</subject><subject>Insufflation</subject><subject>Laparoscopy - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pancreatitis</subject><subject>Pancreatitis, Acute Necrotizing - surgery</subject><subject>Postoperative Complications</subject><subject>Retroperitoneal Space</subject><subject>Retrospective Studies</subject><subject>Saline Solution</subject><subject>Therapeutic Irrigation</subject><subject>Young Adult</subject><issn>0007-1323</issn><issn>1365-2168</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kU1PFTEUhhujkQu44A-YJrpwM9DTj5kpOyWiEggLcD0pnTPYm5l2bDsx1z_g36ZwURMSVv04z3PanJeQA2CHwBg_ulmnQ4Aa9AuyAlGrikPdviQrxlhTgeBih-ymtGYMBFP8NdkRXEoNSq7Inwvn3WTGyliLKdGIOYYZo8vBoxnpbLyNaLKz1KONIaHNYdrQIUTq_FBO2G8r2f12_va_kF06poZOy1hk9DkiTXnpNzQM5TplnKtlpmaeYzD2xz55NZgx4ZvHdY98P_18ffK1Or_88u3k43llhWx1ZcDUfSuUkf0gFapBW8t6LUApyzVr0aoWpEAu0HDdDFLWDUjNsbkXahR75MO2b3n254Ipd5NLFsfReAxL6rhktWp000JB3z1B12GJvvyuUKKW0GghC_X2kVpuJuy7OZZxxk33d8QFONoCv9yIm391YN19dl3JrnvIrvt0dvWwKcb7rRGW-Xle3AGcdpkd</recordid><startdate>202009</startdate><enddate>202009</enddate><creator>Liu, Z-W</creator><creator>Yang, S-Z</creator><creator>Wang, P-F</creator><creator>Feng, J</creator><creator>He, L</creator><creator>Du, J-D</creator><creator>Xiao, Y-Y</creator><creator>Jiao, H-B</creator><creator>Zhou, F-H</creator><creator>Song, Q</creator><creator>Zhou, M-T</creator><creator>Xin, X-L</creator><creator>Chen, J-Y</creator><creator>Ren, W-Z</creator><creator>Lu, S-C</creator><creator>Cai, S-W</creator><creator>Dong, J-H</creator><general>Oxford University Press</general><general>John Wiley & Sons, Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3163-276X</orcidid></search><sort><creationdate>202009</creationdate><title>Minimal-access retroperitoneal pancreatic necrosectomy for infected necrotizing pancreatitis: a multicentre study of a step-up approach</title><author>Liu, Z-W ; Yang, S-Z ; Wang, P-F ; Feng, J ; He, L ; Du, J-D ; Xiao, Y-Y ; Jiao, H-B ; Zhou, F-H ; Song, Q ; Zhou, M-T ; Xin, X-L ; Chen, J-Y ; Ren, W-Z ; Lu, S-C ; Cai, S-W ; Dong, J-H</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3489-a1a6d835a4df45e5f9cc0d93155c2908ec58143e23ea297f44671492e74df46e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Carbon Dioxide</topic><topic>Catheters</topic><topic>Conversion to Open Surgery</topic><topic>Debridement - methods</topic><topic>Drainage</topic><topic>Female</topic><topic>Humans</topic><topic>Insufflation</topic><topic>Laparoscopy - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pancreatitis</topic><topic>Pancreatitis, Acute Necrotizing - surgery</topic><topic>Postoperative Complications</topic><topic>Retroperitoneal Space</topic><topic>Retrospective Studies</topic><topic>Saline Solution</topic><topic>Therapeutic Irrigation</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liu, Z-W</creatorcontrib><creatorcontrib>Yang, S-Z</creatorcontrib><creatorcontrib>Wang, P-F</creatorcontrib><creatorcontrib>Feng, J</creatorcontrib><creatorcontrib>He, L</creatorcontrib><creatorcontrib>Du, J-D</creatorcontrib><creatorcontrib>Xiao, Y-Y</creatorcontrib><creatorcontrib>Jiao, H-B</creatorcontrib><creatorcontrib>Zhou, F-H</creatorcontrib><creatorcontrib>Song, Q</creatorcontrib><creatorcontrib>Zhou, M-T</creatorcontrib><creatorcontrib>Xin, X-L</creatorcontrib><creatorcontrib>Chen, J-Y</creatorcontrib><creatorcontrib>Ren, W-Z</creatorcontrib><creatorcontrib>Lu, S-C</creatorcontrib><creatorcontrib>Cai, S-W</creatorcontrib><creatorcontrib>Dong, J-H</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>British journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liu, Z-W</au><au>Yang, S-Z</au><au>Wang, P-F</au><au>Feng, J</au><au>He, L</au><au>Du, J-D</au><au>Xiao, Y-Y</au><au>Jiao, H-B</au><au>Zhou, F-H</au><au>Song, Q</au><au>Zhou, M-T</au><au>Xin, X-L</au><au>Chen, J-Y</au><au>Ren, W-Z</au><au>Lu, S-C</au><au>Cai, S-W</au><au>Dong, J-H</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Minimal-access retroperitoneal pancreatic necrosectomy for infected necrotizing pancreatitis: a multicentre study of a step-up approach</atitle><jtitle>British journal of surgery</jtitle><addtitle>Br J Surg</addtitle><date>2020-09</date><risdate>2020</risdate><volume>107</volume><issue>10</issue><spage>1344</spage><epage>1353</epage><pages>1344-1353</pages><issn>0007-1323</issn><eissn>1365-2168</eissn><abstract>Abstract
Background
Various minimally invasive approaches have been described for infected necrotizing pancreatitis. This article describes a modified minimal-access retroperitoneal pancreatic necrosectomy (MARPN) procedure assisted by gas insufflation.
Methods
This retrospective, observational study documented patients who had undergone a step-up MARPN between 1 January 2010 and 31 December 2016. A minimum follow-up of 1 year was required for inclusion. The step-up approach involved percutaneous catheter drainage followed by the modified MARPN and necrosectomy. If more than one access site was needed it was categorized as complex MARPN.
Results
Of 212 patients with infected necrotizing pancreatitis, 164 (77·4 per cent) underwent a step-up approach. The median number of percutaneous catheter drains and MARPN procedures was 3 (range 1–7) and 1 (1–6) respectively. Ninety patients (54·9 per cent) underwent complex MARPN. For residual necrosis after MARPN, three patients (1·8 per cent) underwent sinus tract gastroscopy, and 11 (6·7 per cent) had sinography combined with a tube change. However, operations in 13 patients (7·9 per cent) required conversion to open surgery. Postoperative complications developed in 103 patients (62·8 per cent). The mortality rate was 6·1 per cent (10 deaths).
Conclusion
A step-up approach using a modified MARPN for infected necrotizing pancreatitis is a reasonable option.
Graphical Abstract
Minimally invasive approaches have been used increasingly in the management of infected necrotizing pancreatitis. This study presents a modified minimal-access retroperitoneal pancreatic necrosectomy procedure assisted by carbon dioxide insufflation, instead of saline. A clear field of view without necrotic debris floating in saline makes the technique safe and efficient.
Graphical Abstract
High degree of successVIDEO
Presented in part to the Joint Congress of the Sixth Biennial Congress of the Asian–Pacific Hepato-Pancreato-Biliary Association and the 29th Meeting of the Japanese Society of Hepato-Biliary-Pancreatic Surgery, Yokohama, Japan, June 2017</abstract><cop>Chichester, UK</cop><pub>Oxford University Press</pub><pmid>32449154</pmid><doi>10.1002/bjs.11619</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-3163-276X</orcidid></addata></record> |
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| subjects | Adult Aged Aged, 80 and over Carbon Dioxide Catheters Conversion to Open Surgery Debridement - methods Drainage Female Humans Insufflation Laparoscopy - methods Male Middle Aged Pancreatitis Pancreatitis, Acute Necrotizing - surgery Postoperative Complications Retroperitoneal Space Retrospective Studies Saline Solution Therapeutic Irrigation Young Adult |
| title | Minimal-access retroperitoneal pancreatic necrosectomy for infected necrotizing pancreatitis: a multicentre study of a step-up approach |
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