Мultimodal staged tactics of surgical treatment in patients, suffering an acute necrotic pancreatitis
Objective. To estimate the efficacy of the tactics elaborated for the multimodal staged surgical treatment of an acute necrotic pancreatitis (ANP).
Маterials and methods. There were studied the results of treatment of 317 patients, suffering ANP, to whom in 2013-2017 yrs a proposed tactics of the surgical interventions performance was applied. For estimation of the treatment efficacy there were analyzed the organ’s insufficiency, revealed for the first time after the operation, the intensive therapy duration, postoperative complications and lethality.
Results. Application of tactics proposed have provided the performance rate of wide laparotomic necrsequestrectomy down to 14.5% and its deferment till after the fourth week from the disease beginning in 82.6% оperated patients. In postoperative period the complications were observed in 28.3% patients, general lethality have constituted 3.5%, while after performance of wide laparotomic necrsequestrectomies - 6.5%.
Conclusion. Application of a multimodal staged surgical treatment of patients, suffering an ANP, provides the rate reduction for performance of wide laparotomic necrsequestectomy and a morbidity rate as well.
2. Alsfasser G, Schwandner F, Pertschy A, Hauenstein K, Foitzik T, Klar E. Treatment of necrotizing pancreatitis: redefining the role of surgery. World J Surg. 2012 Oct; 36(5):1142-7. doi: 10.1007/s00268-012-1504-5.
3. Poves I, Burdio F, Dorcaratto D, Grande L. Minimally invasive techniques in the treatment of severe acute pancreatitis. Cent Eur J Med. 2014 Aug;9(4):580-5. doi: 10.2478/s11536-013-0283-1.
4. Busquets J, Pelaez N, Secanella L. Evolution and results of the surgical management of 143 cases of severe acute pancreatitis in areferral center. Cir Esp. 2014 Sept;92(9):595-603. doi: 10.1016/j.cireng.2014.04.005.
5. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013 Jun;13(Suppl.1):e1-e15. doi: 10.1016/j.pan.2013.07.063.
6. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis 2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013 Jan;62(1):102-11. doi: 10.1136/gutjnl-2012-302779.
7. Rotar OV, Khomiak IV, Nazarchuk MF, Rotar VI, Khomiak AI. Prognosis and early diagnosis of local and systemic infected complications of acute necrotizing pancreatitis. Pancreatology 2018 June; 18(4 Suppl):169. doi: 10.1016/j.pan.2018.05.457.
8. Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013 Jul;108(6):1400-16. doi: 10.1038/ajg.2013.218.
9. Bakker OJ, van Santvoort HC, van Brunschot S, Geskus RB, Besselink MG, Bollen TL, et al. Endoscopic transgastric versus surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA 2012 Mar;307(10):1084-5. doi: 10.1001/jama.2012.276.
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