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Lu B, Yin JJ, Wang JR, Xu X, Cai Y. Combination of ultrasonic lithotripsy system and video-assisted retroperitoneal debridement in treatment of laterally located pancreatic walled-off necrosis. Hepatobiliary Pancreat Dis Int 2024:S1499-3872(24)00073-0. [PMID: 38839504 DOI: 10.1016/j.hbpd.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Bei Lu
- Department of Hepato-pancreato-biliary Surgery, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou 310006, China
| | - Jun-Jie Yin
- Department of Hepato-pancreato-biliary Surgery, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou 310006, China
| | - Jing-Rui Wang
- Department of Hepato-pancreato-biliary Surgery, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou 310006, China
| | - Xiao Xu
- Department of Hepato-pancreato-biliary Surgery, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou 310006, China
| | - Yang Cai
- Department of Hepato-pancreato-biliary Surgery, Affiliated Hangzhou First People's Hospital, Westlake University School of Medicine, Hangzhou 310006, China.
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Alzerwi N. Surgical management of acute pancreatitis: Historical perspectives, challenges, and current management approaches. World J Gastrointest Surg 2023; 15:307-322. [PMID: 37032793 PMCID: PMC10080605 DOI: 10.4240/wjgs.v15.i3.307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/19/2022] [Accepted: 02/15/2023] [Indexed: 03/27/2023] Open
Abstract
Acute pancreatitis (AP) is a serious condition presenting catastrophic consequences. In severe AP, the mortality rate is high, and some patients initially diagnosed with mild-to-moderate AP can progress to a life-threatening severe state. Treatment of AP has evolved over the years. Drainage was the first surgical procedure performed for AP; however, later, surgical approaches were replaced by more conservative approaches due to the availability of advanced medical care and improved understanding of the course of AP. Currently, surgery is used to manage several complications of AP, such as pseudocysts, pancreatic fistulas, and biliary tract obstruction. Patients who are unresponsive to conservative treatment or have complications are typically considered for surgical intervention. This review focuses on the surgical approaches (endoscopic, percutaneous, and open) that have been established in recent studies to treat this acute condition and summarizes the common management guidelines for AP, discussing the relevant indications, significance, and complications. It is evident that despite their reduced involvement, surgeons lead the multidisciplinary care of patients with AP; however, given the gaps in existing knowledge, more research is required to standardize surgical protocols for AP.
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Affiliation(s)
- Nasser Alzerwi
- Department of Surgery, Majmaah University, Riyadh 11952, Saudi Arabia
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Ebrahim M, Werge MP, Hadi A, Lahchich M, Nagras ZG, Lauritsen ML, Schmidt PN, Hansen EF, Novovic S, Karstensen JG. Clinical outcomes following endoscopic or video-assisted retroperitoneal management of acute pancreatitis with large (>15 cm) walled-off pancreatic necrosis: Retrospective, single tertiary center cohort study. Dig Endosc 2022; 34:1245-1252. [PMID: 35258123 DOI: 10.1111/den.14295] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/25/2022] [Accepted: 03/03/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Acute pancreatitis with walled-off necrosis (WON) is associated with considerable morbidity and mortality. Previous studies have evaluated outcomes in WON collections of limited size, while data about large WON with long-term follow-up are lacking. We aimed to report our experience in managing large WON. METHODS Between 2010 and 2020, consecutive patients with large (>15 cm) WON were identified from a prospectively maintained database. Patients with chronic pancreatitis or an index intervention 90 days or more from the debut of symptoms were excluded. We registered clinical and technical outcomes following minimally invasive treatment in WON >15 cm. Follow-up was a minimum of 1 year. RESULTS Overall, 144 patients with WON >15 cm, with a median age of 60 (interquartile range [IQR] 49-69) years, were included. The median WON size was 19.2 cm (IQR 16.8-22.1). Most patients were treated with endoscopic transluminal drainage (93%). The median length of stay was 53 days (IQR 39-76) and 61 (42%) patients needed intensive care support during their hospital stay. As 143 patients (99%) were managed using endoscopic or video-assisted retroperitoneal techniques, only one (0.7%) patient needed an open necrosectomy. Procedure-related adverse events occurred in 10 (7%) patients. Overall, 24 patients (17%) died during admission, all due to multiorgan failure. The median follow-up was 35 months (IQR 15-63.5). Complete resolution was achieved in all remaining patients. CONCLUSION Minimally invasive treatment of large WON is feasible, with a minimal need for surgery and acceptable rates of morbidity and mortality.
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Affiliation(s)
- Mohamed Ebrahim
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Mikkel Parsberg Werge
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Amer Hadi
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Mariam Lahchich
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Zainab Gassem Nagras
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Morten Laksáfoss Lauritsen
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Palle Nordblad Schmidt
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Erik Feldager Hansen
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Srdan Novovic
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - John Gásdal Karstensen
- Pancreatitis Centre East, Gastrounit, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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