title: Selective Necrosectomy for Infected Pancreatic Necrosis.
abstract: BACKGROUND
  Until recently, a diagnosis of infected pancreatic necrosis (IPN) warranted necrosectomy, which was associated with high morbidity and mortality rates greater than 20%. Preoperative percutaneous drainage delayed the need for necrosectomy with improved outcomes.
  
  
  METHODS
  In 2008, this institution changed its approach to the management of such cases opting instead for percutaneous drainage with selective deferred necrosectomy. A total of 38 consecutive patients with IPN from January 2008 to December 2014 were included.
  
  
  RESULTS
  All 38 underwent percutaneous radiological drainage, and selective necrosectomy was performed on 15 where the infected necrosis did not completely resolve. Twenty-three patients did not require surgery and were managed with pancreatic drain insertion, optimal nutritional support and critical care interventions. Median peak Acute Physiology and Chronic Health Evaluation and Sequential Organ Failure Assessment scores were 10 (range 0-18) and 3 (range 0-10) prior to radiological intervention. Overall mortality was 5% (n = 2).
  
  
  CONCLUSIONS
  This study demonstrates that radiological-guided drainage of infected pancreatic collections can, in most cases, prove curative and, if not, facilitates delayed surgical intervention with improved outcomes.
authors.affiliation: Department of Surgery, Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: Ola
authors.initials: O
authors.lastname: Ahmed
authors.forename: Claire L
authors.initials: CL
authors.lastname: Donohoe
authors.forename: Daragh B
authors.initials: DB
authors.lastname: Murphy
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Marsh
authors.forename: John
authors.initials: J
authors.lastname: Conneely
authors.forename: Gerry P
authors.initials: GP
authors.lastname: McEntee
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000601:surgery; D019283:Pancreatitis, Acute Necrotizing / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D018579:Patient Selection; D015642:Radiology, Interventional; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Hepatobiliary surgery; Pancreatitis; Radiology