title: Analysis of residual pancreatic bed necrosis using computed tomography following minimally invasive necrosectomy.
abstract: OBJECTIVE
  In a unit practicing minimally invasive pancreatic necrosectomy (MIPN), our aim was to assess whether tomographic residual necrotic volume was an objective indicator for repeat necrosectomy.
  
  
  METHODS
  Prospective study of acute pancreatitis admissions. Patients with infected pancreatic necrosis or deteriorating sepsis had MIPN. Outcome parameters included necrotic volumes, conversion rate, morbidity, and mortality.
  
  
  RESULTS
  Thirty patients were admitted with acute pancreatitis of which 15 required organ support. Twenty-nine necrosectomy sessions were performed. Average time from admission to necrosectomy was 39.7 days with an internecrosectomy interval of 6 to 14 days. Mean reduction of necrosis volume was 89.5% and postnecrosectomy volumes were variable. Mean length of hospital and intensive care unit stay was 124.3 and 40.2 days, respectively. Complications included bleeding, pancreatic fistula, and gastric outlet obstruction. No in-hospital deaths or conversions occurred.
  
  
  CONCLUSIONS
  Frequent MIPN achieves substantial pancreatic bed volume reduction with no conversions. Repetitive tomographic scanning is of limited use as an indicator for renecrosectomy.
authors.affiliation: Hepato-pancreatico-biliary Unit, Royal Surrey County Hospital, Guildford, Surrey, England. ahmedhamouda@hotmail.com
authors.forename: Ahmed
authors.initials: A
authors.lastname: Hamouda
authors.forename: Steve
authors.initials: S
authors.lastname: Romans
authors.forename: Hanna
authors.initials: H
authors.lastname: Davidson
authors.forename: Tim
authors.initials: T
authors.lastname: Worthington
authors.forename: Neville
authors.initials: N
authors.lastname: Menezes
authors.forename: Nariman
authors.initials: N
authors.lastname: Karanjia
mesh_terms: D000328:Adult; D000368:Aged; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010180:Pancreatectomy / Q000379:methods*; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging* / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome