Negative pressure irrigation and endoscopic necrosectomy through man-made sinus tract in infected necrotizing pancreatitis: a technical report.
BACKGROUND
In recent years, a step-up approach based on minimally invasive techniques was recommended by latest guidelines as initial invasive treatment for infected pancreatic necrosis (IPN). In this study, we aimed to describe a novel step-up approach for treating IPN consisting of four steps including negative pressure irrigation (NPI) and endoscopic necrosectomy (ED) as a bridge between percutaneous catheter drainage (PCD) and open necrosectomy METHODS: A retrospective review of a prospectively collected internal database of patients with a diagnosis of IPN between Jan, 2012 to Dec, 2012 at a single institution was performed. All patients underwent the same drainage strategy including four steps: PCD, NPI, ED and open necrosectomy. The demographic characteristics and clinical outcomes of study patients were analyzed.


RESULTS
A total of 71 consecutive patients (48 males and 23 females) were included in the analysis. No significant procedure-related complication was observed and the overall mortality was +21.1 % (15 of 71 patients). Seven different strategies like PCD+ NPI, PCD+NPI+ED, PCD+open necrosectomy, etcetera, were applied in study patients and a half of them received PCD alone. In general, each patient underwent a median of 2 drainage procedures and the median total drainage duration was 11 days (interquartile range, 6-21days).


CONCLUSIONS
This four-step approach is effective in treating IPN and adds no extra risk to patients when compared with other latest step-up strategies. The two novel techniques (NPI and ED) could offer distinct clinical benefits without posing unanticipated risks inherent to the procedures.
SICU, Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, People's Republic of China.
Zhihui
Z
Tong
SICU, Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, People's Republic of China.
Lu
L
Ke
SICU, Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, People's Republic of China.
Baiqiang
B
Li
SICU, Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, People's Republic of China.
Gang
G
Li
SICU, Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, People's Republic of China.
Jing
J
Zhou
SICU, Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, People's Republic of China.
Xiao
X
Shen
SICU, Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, People's Republic of China. njzy_pancrea@163.com.|Department of SICU, Research Institute of General Surgery, Jinling Hospital, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu Province, China. njzy_pancrea@163.com.
Weiqin
W
Li
Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, People's Republic of China.
Ning
N
Li
Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing, 210002, People's Republic of China.
Jieshou
J
Li
D000328:Adult; D000368:Aged; D004322:Drainage / Q000379:methods*; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000601:surgery*; D012189:Retrospective Studies; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D055815:Young Adult
Endoscopic necrosectomy; Infected pancreatic necrosis; Negative pressure irrigation; Percutaneous catheter drainage