Combined Surgical Tactics with Step-up Approach in the Treatment of Infected Acute Pancreatitis

Keywords: infected acute pancreatitis, minimally invasive surgery, open surgery, results

Abstract

Objective. To evaluate the results of treatment using minimally invasive interventions and open necrectomy in patients with infected acute pancreatitis.

Materials and methods. A retrospective cohort two-centered analysis was performed in 211 patients with infected acute pancreatitis who divided into two groups: the first included 101 patients, in the treatment of which used open surgery; the second included 110 patients, in the treatment of which used treatment tactic step-up approach.

Results. In the first group used open necrosectomy with drainage for postoperative lavage (75 patients, 74.3%), including open packing with planned re-laparotomy (8 patients, 7.9%), and omentobursostomy for necrosectomy after surgery (18 patients, 17.8%). Postoperative complications occurred in 58 (57.4%), after the surgery 34 (33.7%) patients was died: 30 had a thirty-day mortality, and 4 had a ninety-day mortality. In the second group group, 72 (65.5%) patients were treated by percutaneous catheter drainage, 6 (5.5%) by video-assisted retroperitoneal debridement and drainage, 5 (4.5%) by through the wall of the stomach or duodenum in the infected pseudocyst and open necrosectomy was performed on 27 (24.5%) patients. Postoperative complications occurred in 37 (33.6%) patients, after the surgery 19 (17.3%) was died: 15 had a thirty -day mortality and 4 had a ninety-day mortality. In the regression analysis, only the presence of multiple organ dysfunction before (AUC = 0.867) and after surgery (AUC = 0.930) significantly affected postoperative mortality, but the effect of the prevalence of pancreatic necrosis (AUC = 0.693) on mortality was limited. Differences were likely between groups (χ2=7.282, p=0.026).

Conclusion. The surgical treatment should be initiated with a minimally invasive procedures and combination these operations with open surgery was able to reduce complications and mortality in the patients with infected acute pancreatitis.

Author Biographies

I. A. Kryvoruchko, Kharkiv National Medical University

Kryvoruchko Igor A., MD, DSci(Med), full professor,
Chief of the Department of Surgery No 2
Kharkiv National Medical University, Ukraine.
4 Nauky Ave., 61022, Kharkiv, Ukraine,
+380577077380
ikryvoruchko60@gmail.com
https://orcid.org/0000-0002-5525-701Х

V. V. Boyko, Zaitcev Institute of General and Emergency Surgery, Kharkiv

Boyko Valeriy V., MD, DSci(Med), full professor,
Director of Zaytsev Institute of General and Urgent Surgery
Head of department of surgery No 1
Kharkiv National Medical University
Adress: 1 Balakireva entry, 61103, Kharkiv, Ukraine,
tel.: +38(057)3494125
doctorvaleriy88@ukr.net
https://orcid.org/0000-0002-3455-9705

K. Yu. Parkhomenko, Regional Clinical Hospital, Kharkiv

Parkhomenko Kyril Yuriyovych - MD, PhD, Associate Professor
Kharkiv National Medical University,
Head of Department of Surgery
Kharkiv Regional Clinical Hospital, Kharkiv, Ukraine.
https://orcid.org/0000-0002-0004-2417

A. G. Drozdova, Kharkiv National Medical University

Drozdova Anastasiya Gennadievna - MD, graduate student
Department of Surgery No. 2
Kharkiv National Medical University, Ukraine.
4 Nauki ave., 61022, Kharkiv, Ukraine
https://orcid.org/0000-0002-4401-8048

S. A. Andreieshchev, Shupyk National Medical Academy of Postgraduate Education, Kyiv

Andreieshchev Sergii A., MD, PhD, associate professor,
associate professor Department of Surgery and Transplantology,
Shupyk National Medical Academy of Postgraduate Education, Kyiv
30 Heroiv Sevastopolia Str., 03680, Kyiv, Ukraina,
+38 (044) 4081811
info@hirurgiya.com.ua
http://orcid.org/0000-0002-2281-1803

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Published
2020-06-26
How to Cite
Kryvoruchko, I. A., Boyko, V. V., Parkhomenko, K. Y., Drozdova, A. G., & Andreieshchev, S. A. (2020). Combined Surgical Tactics with Step-up Approach in the Treatment of Infected Acute Pancreatitis. Klinicheskaia Khirurgiia, 87(3-4), 3-9. https://doi.org/10.26779/2522-1396.2020.3-4.03
Section
General Problems of Surgery