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Wei W, Tang Y, Peng Z, Xie J, Deng Z, Yuan T, Tang C, Pi R, Wang S, Zhao S, Wang L, Li C, Wang Y, Zhang P, Wu Z, Wan Y, Ma Y, Tang W, Liang X, Liu K, Wang W, Liang X, Zeng D, Li S, Liu H. Minimal-access video-assisted retroperitoneal and/or transperitoneal debridement (VARTD) in the management of infected walled-off pancreatic necrosis with deep extension: initial experience from a prospective single-arm study. Eur J Med Res 2023; 28:72. [PMID: 36755332 PMCID: PMC9909852 DOI: 10.1186/s40001-023-01030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/24/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND The currently preferred minimally invasive approaches have substantially improved outcomes of infected walled-off pancreatic necrosis (iWON). However, iWON with deep extension (iWONde) still poses a tricky challenge for sufficient necrosis evacuation by one stand-alone approach, often requiring repeated interventions. The aim of this study was to assess the effectiveness and safety of a minimal-access video-assisted retroperitoneal and/or transperitoneal debridement (hereafter called VARTD) in the management of iWONde. METHODS Patients who had developed an iWONde were recruited to receive the VARTD in this prospective single-arm study. The primary efficacy endpoint was clinical improvement up to day 28 after the VARTD, defined as a ≥ 75% reduction in size of necrotic collection (in any axis) on CT and clinical resolution of sepsis or organ dysfunction. The primary safety endpoint was a composite of major complications or death during follow-up. Six-month postdischarge follow-up was available. RESULTS Between July 18, 2018, and November 12, 2020, we screened 95 patients with necrotizing pancreatitis; of these, 21 iWONde patients (mean [SD] age, 42.9 [11.7] years; 10 [48%] women) were finally enrolled. The primary efficacy endpoint was achieved by most participants (14/21, 67%). No participants required repeated interventions. The primary safety endpoint occurred in six patients (29%). Except one in-hospital death attributable to repeated intra-abdominal hemorrhage, others were discharged without any major complication. CONCLUSIONS The VARTD approach appears to have a reasonable efficacy with acceptable complication rates and thus might be an option for improving clinical management of iWONde. TRIAL REGISTRATION This study is registered with Chinese Clinical Trial Registry (chictr.org.cn number, ChiCTR1800016950).
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Affiliation(s)
- Wanjie Wei
- grid.410570.70000 0004 1760 6682Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, 10 Changjiang Branch Rd, Yuzhong District, Chongqing, 400042 China
| | - Yongliang Tang
- grid.410570.70000 0004 1760 6682Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, 10 Changjiang Branch Rd, Yuzhong District, Chongqing, 400042 China
| | - Zuxiang Peng
- grid.410570.70000 0004 1760 6682Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, 10 Changjiang Branch Rd, Yuzhong District, Chongqing, 400042 China
| | - Jun Xie
- grid.410570.70000 0004 1760 6682Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, 10 Changjiang Branch Rd, Yuzhong District, Chongqing, 400042 China
| | - Zhaoxia Deng
- grid.410570.70000 0004 1760 6682Department of Emergency, Southwest Hospital, Army Medical University, Chongqing, China
| | - Tao Yuan
- grid.410570.70000 0004 1760 6682Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, 10 Changjiang Branch Rd, Yuzhong District, Chongqing, 400042 China
| | - Chun Tang
- grid.410570.70000 0004 1760 6682Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, 10 Changjiang Branch Rd, Yuzhong District, Chongqing, 400042 China
| | - Ruxian Pi
- grid.410570.70000 0004 1760 6682Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, 10 Changjiang Branch Rd, Yuzhong District, Chongqing, 400042 China
| | - Shunan Wang
- grid.410570.70000 0004 1760 6682Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Siqi Zhao
- grid.410570.70000 0004 1760 6682Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Lu Wang
- grid.410570.70000 0004 1760 6682Department of Radiology, Daping Hospital, Army Medical University, Chongqing, China
| | - Chunxue Li
- grid.410570.70000 0004 1760 6682Department of General Surgery, Daping Hospital, Army Medical University, Chongqing, China
| | - Yaoli Wang
- grid.410570.70000 0004 1760 6682Intensive Care Unit, Daping Hospital, Army Medical University, Chongqing, China
| | - Peng Zhang
- grid.410570.70000 0004 1760 6682Intensive Care Unit, Daping Hospital, Army Medical University, Chongqing, China
| | - Zhengbin Wu
- grid.410570.70000 0004 1760 6682Intensive Care Unit, Daping Hospital, Army Medical University, Chongqing, China
| | - Yafeng Wan
- grid.410570.70000 0004 1760 6682Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, 10 Changjiang Branch Rd, Yuzhong District, Chongqing, 400042 China
| | - Yan Ma
- grid.410570.70000 0004 1760 6682Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, 10 Changjiang Branch Rd, Yuzhong District, Chongqing, 400042 China
| | - Wen Tang
- grid.410570.70000 0004 1760 6682Department of Gastroenterology, Daping Hospital, Army Medical University, Chongqing, China
| | - Xianchun Liang
- grid.410570.70000 0004 1760 6682Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, 10 Changjiang Branch Rd, Yuzhong District, Chongqing, 400042 China
| | - Kun Liu
- grid.410570.70000 0004 1760 6682Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, 10 Changjiang Branch Rd, Yuzhong District, Chongqing, 400042 China
| | - Wei Wang
- grid.410570.70000 0004 1760 6682Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, 10 Changjiang Branch Rd, Yuzhong District, Chongqing, 400042 China
| | - Xianyi Liang
- grid.410570.70000 0004 1760 6682Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, 10 Changjiang Branch Rd, Yuzhong District, Chongqing, 400042 China
| | - Dongmei Zeng
- grid.410570.70000 0004 1760 6682Department of Information, Daping Hospital, Army Medical University, Chongqing, China
| | - Shan Li
- Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, 10 Changjiang Branch Rd, Yuzhong District, Chongqing, 400042, China.
| | - Hongming Liu
- Department of Hepatobiliary Surgery, Daping Hospital, Army Medical University, 10 Changjiang Branch Rd, Yuzhong District, Chongqing, 400042, China.
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Baeza-Zapata AA, García-Compeán D, Jaquez-Quintana JO. Acute Pancreatitis in Elderly Patients. Gastroenterology 2021; 161:1736-1740. [PMID: 34384746 DOI: 10.1053/j.gastro.2021.06.081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/23/2021] [Accepted: 06/27/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Armando A Baeza-Zapata
- Gastroenterology Service, Department of Internal Medicine, Faculty of Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Diego García-Compeán
- Gastroenterology Service, Department of Internal Medicine, Faculty of Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Joel O Jaquez-Quintana
- Gastroenterology Service, Department of Internal Medicine, Faculty of Medicine, University Hospital "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
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Lu Z, Zhu X, Hua T, Zhang J, Xiao W, Jia D, Yang M. Efficacy and safety of abdominal paracentesis drainage on patients with acute pancreatitis: a systematic review and meta-analysis. BMJ Open 2021; 11:e045031. [PMID: 34373293 PMCID: PMC8354272 DOI: 10.1136/bmjopen-2020-045031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To conduct a systematic review and meta-analysis of the efficacy and safety of abdominal paracentesis drainage (APD) in patients with acute pancreatitis (AP) when compared with conventional 'step-up' strategy based on percutaneous catheter drainage (PCD). DESIGN Systematic review and meta-analysis. METHODS PubMed, EMBASE, Cochrane Library, MEDLINE (OVID), China National Knowledge Infrastructure and Wanfang Database were electronically searched to collect cohort studies and randomised controlled trials (RCTs) from inception to 25 July 2020. Studies related to comparing APD with conventional 'step-up' strategy based on PCD were included. OUTCOMES The primary outcome was all-cause mortality. The secondary outcomes were the rate of organ dysfunction, infectious complications, hospitalisation expenses and length of hospital stay. RESULTS Five cohort studies and three RCTs were included in the analysis. Compared with the conventional 'step-up' method, pooled results suggested APD significantly decreased all-cause mortality during hospitalisation (cohort studies: OR 0.48, 95% CI 0.26 to 0.89 and p=0.02), length of hospital stay (cohort studies: standard mean difference (SMD) -0.31, 95% CI -0.53 to -0.10 and p=0.005; RCTs: SMD -0.45, 95% CI -0.64 to -0.26 and p<0.001) and hospitalisation expenses (cohort studies: SMD -2.49, 95% CI -4.46 to -0.51 and p<0.001; RCTs: SMD -0.67, 95% CI -0.89 to -0.44 and p<0.001). There was no evidence to prove that APD was associated with a higher incidence of infectious complications. However, the incidence of organ dysfunction between cohort studies and RCTs subgroup slightly differed (cohort studies: OR 0.66, 95% CI 0.34 to 1.28 and p=0.22; RCTs: OR 0.58, 95% CI 0.35 to 0.98 and p=0.04). CONCLUSIONS The findings suggest that early application of APD in patients with AP is associated with reduced all-cause mortality, expenses during hospitalisation and the length of stay compared with the 'step-up' strategy without significantly increasing the risk of infectious complications. These results must be interpreted with caution because of the limited number of included studies as well as a larger dependence on observational trials. PROSPERO REGISTRATION NUMBER CRD42020168537.
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Affiliation(s)
- Zongqing Lu
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xingxing Zhu
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Tianfeng Hua
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jin Zhang
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wenyan Xiao
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Di Jia
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Min Yang
- The 2nd Department of Intensive Care Unit, Second Affiliated Hospital of Anhui Medical University, Hefei, China
- The Laboratory of Cardiopulmonary Resuscitation and Critical Care Medicine, Second Affiliated Hospital of Anhui Medical University, Hefei, China
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Hori T, Ogawa K, Yamamoto H, Harada H, Matsumura K, Yamamoto M, Yamada M, Yazawa T, Kuriyama K, Tani M, Yasukawa D, Kamada Y, Aisu Y, Tani R, Aoyama R, Nakayama S, Sasaki Y, Nishimoto K, Zaima M. Impact of continuous local lavage on pancreatic juice-related postoperative complications: Three case reports. World J Clin Cases 2019; 7:2526-2535. [PMID: 31559288 PMCID: PMC6745316 DOI: 10.12998/wjcc.v7.i17.2526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 07/10/2019] [Accepted: 07/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Postoperative pancreatic leakage readily results in intractable pancreatic fistula and subsequent intraperitoneal abscess. This refractory complication can be fatal; therefore, intensive treatment is important. Continuous local lavage (CLL) has recently been reevaluated as effective treatment for severe infected pancreatitis, and we report three patients with postoperative intractable pancreatic fistula successfully treated by CLL. We also discuss our institutional protocol for CLL for postoperative pancreatic fistula.
CASE SUMMARY The first patient underwent subtotal stomach-preserving pancreaticoduodenectomy, and pancreatic leakage was observed postoperatively. Intractable pancreatic fistula led to intraperitoneal abscess, and CLL near the pancreaticojejunostomy site was instituted from postoperative day (POD) 8. The abscess resolved after 7 d of CLL. The second patient underwent distal pancreatectomy. Pancreatic leakage was observed, and intractable pancreatic fistula led to intraperitoneal abscess near the pancreatic stump. CLL was instituted from POD 9, and the abscess resolved after 4 d of CLL. The third patient underwent aneurysmectomy and splenectomy with wide exposure of the pancreatic parenchyma. Endoscopic retrograde pancreatic drainage was performed on POD 15 to treat pancreatic fistula; however, intraperitoneal abscess was detected on POD 59. We performed CLL endoscopically via the transgastric route because the percutaneous approach was difficult. CLL was instituted from POD 63, and the abscess resolved after 1 wk of CLL.
CONCLUSION CLL has therapeutic potential for postoperative pancreatic fistula.
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Affiliation(s)
- Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Kohei Ogawa
- Department of Hepatobiliary Pancreatic and Breast Surgery, Ehime University, Toon 791-0295, Japan
| | - Hidekazu Yamamoto
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Hideki Harada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Kazuyoshi Matsumura
- Department of Gastroenterology and Hepatology, Shiga General Hospital, Moriyama 524-8524, Japan
| | | | - Masahiro Yamada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Takefumi Yazawa
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Katsutoshi Kuriyama
- Department of Gastroenterology and Hepatology, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Masaki Tani
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Yasuyuki Kamada
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Yuki Aisu
- Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Ryotaro Tani
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Ryuhei Aoyama
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Shinnosuke Nakayama
- Department of Gastroenterology and Hepatology, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Yudai Sasaki
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Koki Nishimoto
- Department of Gastroenterology and Hepatology, Shiga General Hospital, Moriyama 524-8524, Japan
| | - Masazumi Zaima
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Japan
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Tani R, Hori T, Yamamoto H, Harada H, Yamamoto M, Yamada M, Yazawa T, Tani M, Kamada Y, Aoyama R, Sasaki Y, Zaima M. Severely Calcified True Aneurysm: A Thought-Provoking Case of Solitary Origin and Postoperative Management. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:620-627. [PMID: 31031402 PMCID: PMC6501733 DOI: 10.12659/ajcr.915010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patient: Male, 70 Final Diagnosis: Splenic artery aneurysm Symptoms: Asymptomatic Medication: — Clinical Procedure: Surgery and Endoscopy Specialty: Surgery
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Affiliation(s)
- Ryotaro Tani
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Hidekazu Yamamoto
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Hideki Harada
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
| | | | - Masahiro Yamada
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Takefumi Yazawa
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Masaki Tani
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Yasuyuki Kamada
- Department of Surgery, Shiga General Hospital, Moriyama, Japan
| | - Ryuhei Aoyama
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Yudai Sasaki
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
| | - Masazumi Zaima
- Department of Surgery, Shiga General Hospital, Moriyama, Shiga, Japan
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Percutaneous Drainage Versus Peritoneal Lavage for Pancreatic Ascites in Severe Acute Pancreatitis: A Prospective Randomized Trial. Pancreas 2019; 48:343-349. [PMID: 30789387 DOI: 10.1097/mpa.0000000000001251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study aimed to compare the efficacy of percutaneous drainage (PCD) versus peritoneal lavage (PL) for the treatment for severe acute pancreatitis patients with pancreatic ascites (PAs). METHODS Severe acute pancreatitis patients with PAs were randomly assigned within 3 days of onset of symptoms to receive either PL or PCD. The primary end point was a composite of mortality or major complications during hospitalization and within 1 month of discharge. Per-protocol analyses were performed. RESULTS Between September 2011 and June 2014, 86 patients were randomly assigned to intervention with PL or PCD. Ultimately, 41 patients in the PCD group and 39 patients in the PL group completed the study. The primary end point occurred in 15 (36.6%) of 41 patients in the PCD group and in 17 (43.6%) of 39 patients in the PL group (risk ratio, 0.84; 95% confidence interval, 0.49-1.44; P = 0.27). Mortality or major complications did not differ between the groups. Percutaneous drainage reduced intra-abdominal hypertension; however, PL reduced the incidence of deep venous thrombosis and pancreatic encephalopathy and was associated with a reduced need for intervention. CONCLUSIONS In our study, the PCD was not superior to the PL in reducing mortality or major complications in severe acute pancreatitis patients with PAs.
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Peritoneal dialysis beyond kidney failure? J Control Release 2018; 282:3-12. [DOI: 10.1016/j.jconrel.2018.01.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/17/2018] [Indexed: 12/19/2022]
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Effect of intra-abdominally administered mesalazine (5-aminosalicylic acid) in experimental peritonitis. North Clin Istanb 2017; 5:171-175. [PMID: 30688941 PMCID: PMC6323574 DOI: 10.14744/nci.2017.48379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 10/10/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: In this study, the effect of mesalazine was studied on TNF alpha IL-1 beta, IL-6, and C-reactive protein (CRP) levels and inflammatory changes in rat lungs with experimental peritonitis. METHODS: In total, 24 male Sprague–Dawley rats weighing 250–280 g were used in the study.The rats were divided into three groups based on no irrigation or irrigation with isotonic solution or mesalazine. Secondary peritonitis was generated by cecum penetrations. Group I, no irrigation was given after the development of peritonitis; Group II, irrigation was performed using isotonic solution 24 h after the development of peritonitis; Group III: irrigation was performed using mesalazine 24 h after the development of peritonitis. Blood samples were taken in the 48th hour for measuring TNF alpha, IL-1 beta, IL-6, and CRP levels. Lung tissue samples were taken for examining the effect of mesalazine in the development of systemic sepsis. RESULTS: TNF alpha, IL-1 beta, and CRP levels were significantly low in Group III than in the other groups (p<0.005). In the histologic examination, leucocyte infiltration in the lung was found low in Group III. CONCLUSION: TNF alpha, IL-1 beta, and CRP levels and leucocyte infiltration in the lung were found to be low in rats that were administered peritoneal irrigation using mesalazine after the development of secondary peritonitis. Peritoneal irrigation using mesalazine may be useful in patients requiring surgery due to secondary peritonitis.
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Abstract
OBJECTIVE The aim of this study was to assess the efficiency and safety of peritoneal lavage in patients with severe acute pancreatitis. METHODS A comprehensive search was performed to identify randomized controlled trials that compared peritoneal lavage with conservative treatment for severe acute pancreatitis. The primary outcome was all-cause mortality. Secondary outcomes included complications rate, proportion of need for operation, length of hospital stay, and medical costs. RESULTS A total of 899 patients from 15 studies were subjected to this systematic review. Peritoneal lavage did significantly decrease the mortality (relative risk, 0.47; 95% confidence interval, 0.34-0.66; P < 0.01), with low heterogeneity among the studies (I = 7%). Peritoneal lavage also seemed to significantly alter any of the other end points. CONCLUSIONS Peritoneal lavage shows robustly beneficial effect in patients with severe acute pancreatitis in this systematic review. However, the results should be interpreted with caution due to the general high risk of bias in these included studies.
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Zhu L, Lu J, Yang J, Sun P. Early-phase peritoneal drainage and lavage in a rat model of severe acute pancreatitis. Surg Today 2015; 46:371-8. [PMID: 25893772 DOI: 10.1007/s00595-015-1172-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/24/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the effects of early-phase drainage on the survival rates and pancreatic pathological changes associated with severe acute pancreatitis (SAP) in a rat model. METHODS Sprague-Dawley rats were divided into the following groups: SAP model (control), early drainage and delayed drainage. The 24-h survival rates were compared among the groups. In addition, the serum and ascites concentrations of interleukin (IL)-1β, IL-6, IL-8, IL-10 and tumor necrosis factor (TNF)-α were measured, and pancreatic pathological changes were observed. RESULTS The survival rate significantly improved in the early drainage group. Compared with that observed in the control group, the serum TNF-α and IL-8 concentrations in the early drainage group decreased, while the serum IL-10 levels increased, and the ascites concentrations of IL-1β, IL-6, IL-8 and TNF-α decreased, while that of IL-10 increased significantly. In the delayed drainage group, only the ascites concentrations of TNF-α decreased. Meanwhile, the pancreatic pathological changes at 3, 6 and 24 h worsened in the early drainage group; however, the pancreatic lesions in the early drainage group were less mild than those seen in the control group. CONCLUSIONS Rebalancing the cytokine levels in ascites after early drainage may be a key factor for enhancing the survival rate in rats.
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Affiliation(s)
- Leiming Zhu
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336, China.
| | - Jilin Lu
- Department of General Surgery, No. 1 Hospital, Shanghai Jiao Tong University School of Medicine, 85 Wujin Road, Shanghai, 200080, China
| | - Jing Yang
- Department of Pathology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336, China
| | - Peng Sun
- Department of General Surgery, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336, China
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