Surgical and intervention treatment of secondary pancreatic infections

Abstract

Introduction. Many experimental and clinical studies have improved our understanding of the pathophysiology of acute pancreatitis. Today, there are no disagreements over the timing and basic indications for surgery in this disease, but there are still various surgical approaches. Methods. A retrospective and prospective two-center controlled study was conducted in 582 patients with acute pancreatitis treated in 2004–2018. Age of patients was 53 ± 12,5 years. The classification of the disease was used according to the recommendations of the International Consensus 2012. Patients included in the study were treated in accordance with the IAP/APA (2013) recommendations adapted to local resources and procedures. Of 582 patients, 387 (66,5%) patients with mild to moderate heaviness performed complex treatment, including 89 patients undergoing surgery. According to the goals and objectives of the study, other patients were divided into two groups: the main group – 103 patients with secondary pancreatic infection, who used the tactic of treatment «step-up approach»; а comparison group – 92 patients with open surgical intervention. Results. In the comparison group were used open necrosectomy and drainage. Postoperative complicationshavearisenin52 (56,2%)patients. After surgery died 26 patients (28,3%), 19 had a 30-day mortality and 7 had a 90-daymortalityof them. In the main group 62 (60,2%) patients were treated by percutaneous controlled ultrasound intervention, 26 (25,2%) by videolaparoscopic necrosectomy and drainage and at 5 (4,9%) drainage through the wall of the stomach or duodenum. In 10 (9,7%) open operations were performed (minilumbotomy, upper medial, left or right-winged minilaparotomy with formation of mini-bursostomy) with pancreatic necrosectomy, including at 5 decompressive VAC-laparostomy local access. Postoperative complications have arisen in 33 (32%) patients. After surgery died 15 patients (14,6%), 6 had a 30-day mortality and 9 had a 90-day mortality of them. When comparing the two strategies of the treatment-tactical approach, the number of postoperative complications and mortality were lower than in the group of patients who performed only open surgical interventions (х2 = 6,976, p = 0,011). Conclusion. The our research showed that an individualized approach to patients with secondary pancreatic infection using the step-up approach provides a reduction in the number of laparotomic pancreatic necrosectomies and allows postponing «open» surgical interventions for a period after the 4th week from the onset of the disease and reducing the number of postoperative complications and mortality (х2 = 6,976, р = 0,031).

Keywords

• acute pancreatitis
• secondary pancreatic infection
• diagnostics
• tactics «step-up approach»
• surgical treatment