Position of surgical treatment in step-up management of severe acute pancreatitis
Authors:
J. Sedláčková 1; J. Zajak 1; B. Jon 1; J. Maňák 2; S. Rejchrt 3; F. Čečka 1
Authors‘ workplace:
Chirurgická klinika Fakultní nemocnice Hradec Králové a Lékařská fakulta Univerzity Karlovy v Hradci Králové
1; III. Interní gerontometabolická klinika Fakultní nemocnice Hradec Králové a Lékařská fakulta Univerzity Karlovy v Hradci Králové
2; II. interní gastroenterologická klinika Fakultní nemocnice Hradec Králové a Lékařská fakulta Univerzity Karlovy v Hradci Králové
3
Published in:
Rozhl. Chir., 2023, roč. 102, č. 2, s. 64-74.
Category:
Original articles
doi:
https://doi.org/10.33699/PIS.2023.102.2.64–74
Overview
Introduction: The incidence of acute pancreatitis has been increasing over the past twenty years and there is still no causal treatment available. Although cases of severe acute pancreatitis account for only about a fifth of all cases of acute pancreatitis, high morbidity and lethality call for an optimization and unification of treatment procedures.
Methods: We operated on 27 patients suffering from severe acute pancreatitis in the past five years. We compared selected parameters such as gender, age, body mass index, aetiology, presence of type 2 diabetes, BISAP score, previous minimally invasive treatment and presence of the intraabdominal compartment syndrome.
Results: The average age of men and women was similar in our group. Most patients were overweight or obese. Alcoholic aetiology was more common in men while biliary aetiology prevailed in women. The mortality rate was 26% in our group. The intra-abdominal compartment syndrome followed by emergency decompression surgery was present in one fourth of the patients. A minimally invasive approach was used in approximately in one half of the patients, and surgical treatment was used only in cases where the minimally invasive approach failed.
Conclusion: After each surgical revision, clinical deterioration of the patient´s condition occurs during the first two to three days in response to operative stress. Therefore, the current trend in the treatment of acute pancreatitis is to proceed as conservatively as possible, or using the minimally invasive approach, and surgical treatment should be reserved only for conditions that cannot be managed otherwise. If surgical treatment is used, it is advisable to perform cholecystectomy, whatever the aetiology of the pancreatitis.
Keywords:
surgical treatment – acute necrotizing pancreatitis – minimally invasive treatment – step-up approach – intra-abdominal compartment syndrome
Sources
1. Pannala R, Kidd M, Modlin IM. Acute pancreatitis: a historical perspective. Pancreas 2009 May;38(4):355−366. doi: 10.1097/ MPA.0b013e318199161c.
2. Akinfemiwa O, Muniraj T. Amylase. In: StatPearls [Internet], Treasure Island (FL): StatPearls Publishing 2022.
3. Trna J, Kala Z, Kunovský L, et al. Klinická pankreatologie, 2. přepracované a doplněné vydání. Praha, Maxdorf 2021:78−142.
4. Maňák J, Rejchrt S, Andrašina T, et al. Těžká akutní pankreatitida: Adaptovaný doporučený postup (NICE guideline: Pancreatitis, AGA: Initial Medical Treatment of Acute Pancreatitis). Národní portál klinických doporučených postupů. Published in 2022.
5. Zadák Z, Havel E, et al. Intenzivní medicína na principech vnitřního lékařství. 2. doplněné a přepracované vydání. Praha, Grada 2017:287−297.
6. Pagliari D, Brizi MG, Saviano A, et al. Clinical assessment and management of severe acute pancreatitis: a multidisciplinary approach in the XXI century. Eur Rev Med Pharmacol Sci. 2019 Jan;23(2):771−787. doi: 10.26355/eurrev_ 201901_16892.
7. Morato O, Poves I, Ilzarbe L, et al. Minimally invasive surgery in the era of step-up approach for treatment of severe acute pancreatitis. Int J Surg. 2018 Mar;51:164−169 doi: 10.1016/j. ijsu.2018.01.017.
8. Harfouche M, Clark J, Kim K, et al. Characteristics and outcomes of drainage versus surgery first in severe pancreatitis. Am Surg. 2020 Sep;86(9):1073−1077. doi: 10.1177/0003134820943118.
9. Leppaniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019 Jun 13;14:27. doi: 10.1186/s13017-019-0247-0.
10. El Boukili I, Boschetti G, Belkhodja H, et al. Role of surgery in acute necrotizing pancreatitis. J Visc Surg. 2017 Dec;154(6):413−420. doi: 10.1016/j.jviscsurg. 2017.06.008.
11. Ulrych J. Akutní pankreatitida – pohled chirurga. Rozhledy v chirurgii 2019; 98:18−23.
12. Silva-Vaz P, Abrantes AM, Castelo-Branco M, et al. Multifactorial scores and biomarkers of prognosis of acute pancreatitis: Applications to research and practice. Int J Mol Sci. 2020 Jan 4;21(1):338. doi: 10.3390/ijms21010338.
13. Nayar MK, Bekkali NLH, Bourne D, et al. Novel multidisciplinary hub-and-spoke tertiary service for the management of severe acute pancreatitis. BMJ Open Gastroenterol. 2021 Mar;8(1):e000501. doi: 10.1136/bmjgast-2020-000501.
14. Baron TH, DiMaio ChJ, Wang AY, et al. American Gastroenterological Association clinical practice update: Management of pancreatic necrosis. Gastroenterology 2020 Jan;158(1):67−75.e1. doi: 10.1053/j.gastro.2019.07.064.
15. Heckler M, Hackert T, Hu K, et al. Severe acute pancreatitis: surgical indications and treatment. Langenbecks Arch Surg. 2021 May;406(3):521−535. doi: 10.1007/s00423-020-01944-6.
16. Siebert M, Le Fouler A, Sitbon N, et al. Management of abdominal compartment syndrome in acute pancreatitis. J Visc Surg. 2021 Oct;158(5):411−419. doi: 10.1016/j.jviscsurg.2021.01.001.
17. Husu HL, Leppaniemi AK, Mentula PJ. Who would benefit from open abdomen in severe acute pancreatitis? A matched case-control study. World J Emerg Surg. 2021 Jun 10;16(1):32. doi: 10.1186/ s13017-021-00376-x.
18. Soonyoung P, Seungho L, Hyo Deok L, et al. Abdominal compartment syndrome in severe acute pancreatitis treated with percutaneous catheter drainage. Clin Endosc. 2014 Sep;47(5):469−4672. doi: 10.5946/ce.2014.47.5.469.
19. Sorrentino L, Osvaldo Ch, Mutignani M, et al. Combined totally mini-invasive approach in necrotizing pancreatitis: a case report and systematic literature review. World J Emerg Surg. 2017 Mar 16;12:16. doi: 10.1186/s13017-017-0126- 5.
20. Arvanitakis M, Dumonceau JM, Albert J, et al. Endoscopic management of acute necrotizing pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) evidence-based multidisciplinary guidelines. Endoscopy 2018 Apr;50:524−546. doi: 10.1055/a-0588-5365.
21. Lancaster A, Zwijacz M. Acute pancreatitis and fluid filled collections: Etiology and endoscopic management. Gastroenterol Nurs. 2019 Sep/Oct;42(5):417−419. doi: 10.1097/SGA.0000000000000396.
22. Umapathy Ch, Gajendran M, Mann R, et al. Pancreatic fluid collections: Clinical manifestations, diagnostic evaluation and management. Dis Mon. 2020 Nov;66(11):100986. doi: 10.1016/j.disamonth. 2020.100986.
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Surgery Orthopaedics Trauma surgeryArticle was published in
Perspectives in Surgery
2023 Issue 2
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