gms | German Medical Science

129. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

24.04. - 27.04.2012, Berlin

Critical Analysis of Minimal Invasive Necrosectomy for Acute Pancreatitis

Meeting Abstract

  • Ulrich Friedrich Wellner - Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Sebastian Kahl - Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Dirk Bausch - Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Andreas Fischer - Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Stefan Utzolino - Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Ulrich Theodor - Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg
  • Tobias Keck - Universitätsklinikum Freiburg, Allgemein- und Viszeralchirurgie, Freiburg

Deutsche Gesellschaft für Chirurgie. 129. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 24.-27.04.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. Doc12dgch136

DOI: 10.3205/12dgch136, URN: urn:nbn:de:0183-12dgch1369

Veröffentlicht: 23. April 2012

© 2012 Wellner et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Introduction: Recent publications have suggested a “step-up” approach is favored for the treatment of acute necrotizing pancreatitis. The aim of this study was to evaluate the outcome of minimal invasive procedures for necrosectomy in acute pancreatitis.

Material and methods: Patients with acute pancreatitis admitted to our institution from 2001 to 2010 (n>500) were identified by ICD and OPS codes of the electronic patient data files. From these, patients who received minimal invasive procedures (minimal invasive necrosectomy (MINE) and endoscopic transgastric drainage (ETG)) were selected for analysis. Statistical analysis employed two-sided Fisher’s exact test and Mann-Whittney U-test of the SPSS 17.0 software.

Results: From 2002 to 2009, n=32 patients were treated by minimal invasive procedures at our institution. Around 80% of cases constituted the first episode of an acute necrotizing pancreatitis. Procedures performed were 15 MINE and 17 ETG of pancreatic necrosis or walled off pancreatic necrosis. Time from start of symptoms to intervention was shorter for MINE than ETG (median, 4 vs 8 weeks, p<0.05) and therefore, the rate of citically ill patients with sepsis or septic shock was higher in MINE (73% vs 13%, p<0.05). Problems after MINE (vs ETG) were ongoing sepsis (13% vs 6%), bleeding requiring intervention (27% vs 12%) and pancreatic fistula (7% vs 0%). One specific complication of ETG was gastric perforation to the peritoneal cavity during the procedure (30% vs 0% with MINE), requiring immediate open pseudocystogastrostomy. Laparotomy was necessary in 27% after MINE and 41% after ETG, due to specific complications or persistent infected necrosis. Overall Mortality was higher after MINE vs ETG (27% vs 6%, p=0.16).

Conclusion: Morbidity and mortality remains high in acute necrotizing pancreatitis. Operative procedures should be delayed as long as possible to reduce mortality. Minimal invasive procedures can avoid the necessity of laparotomy but also bear specific complications requiring immediate or secondary open operative treatment. They should therefore only be performed at specialized centers.