A new algorithm for surgical treatment of infected pancreatic necrosis

Objective: to improve treatment outcomes in patients with infected pancreatic necrosis through the rational use of minimally invasive technologies.
Materials and methods. A retrospective-prospective analysis of treatment results was conducted on 137 patients with infected pancreatic necrosis. The control group consisted of 53 patients who underwent open necrosectomy. In the main group (84 patients), a developed treatment algorithm was applied using minimally invasive technologies: puncture-draining interventions, video-assisted retroperitoneoscopy, and percutaneous necrectomy.
Results. In the control group, postoperative complications developed in 50 (94.3%) patients, with a mortality rate of 54.7%. In the main group, postoperative complications were observed in 32 (38.1%) patients, with a mortality rate of 33,3%. The developed devices for necrectomy allowed for a reduction in operation time by 45.6% (p = 0.04).
Conclusions: The application of the developed treatment algorithm and instrumentation using minimally invasive technologies allowed for a reduction in the frequency of postoperative complications from 94.3% to 38.1% and mortality from 54.7% to 33,3% in patients with infected pancreatic necrosis.

1. Проценко Д.Н., Цветков Д.С., Шифман Е.М. Тактика инфузионной терапии у больных с острым деструктивным панкреатитом: обзор литературы. Вестник интенсивной терапии имени А.И. Салтанова. 2024;2:94–106.

2. Boxhoorn L., Voermans R.P., Bouwense S.A., et al. Acute pancreatitis. Lancet. 2020;396:726–734. https://doi.org/10.1016/S0140-6736(20)31310-6

3. Пугаев А.В., Ачкасов Е.Е. Острый панкреатит. Москва; 2007:216.

4. Gmeinwieser J., et al. Successful percutaneous treatment of infected necrosis of the body of the pancreas associated with segmental disruption of the main pancreatic duct. Gastrointest. Endosc. 2000;52:413-415.

5. Besselink M.G., et al. Minimally invasive ‘’step-up approach’’ versus maximal necrosectomy in patients with acute necrotising pancreatitis (PANTER trial): design and rationale of a randomised controlled multicenter trial [ISRCTN13975868]. BMC Surg. 2006;6(6):1-10.

6. Besselink M.G., et al. Timing of surgical intervention in necrotizing pancreatitis. Arch. Surg. 2007;142(12):1194-1201.

7. Santvoort van H.C., et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N. Engl. J. Med. 2010;362(16):1491-1502.

8. Литвин А.А. и др. Тактика этапного комбинированного хирургического лечения острого некротизирующего панкреатита. Актуальные вопросы хирургии: материалы XIV съезда хирургов Респ. Беларусь; под ред. А. Н. Косинца. Витебск: ВГМУ, 2010:212.

9. Bausch D., Wellner U., Kahl S., Kuesters S., Richter-Schrag H.J., Utzolino S., et al. Minimally invasive operations for acute necrotizing pancreatitis: comparison of minimally invasive retroperitoneal necrosectomy with endoscopic transgastric necrosectomy. Surgery. 2012 Sep;152(3 Suppl 1):S128eS134.

10. Bakker OJ, van Santvoort HC, van Brunschot S, Geskus RB, Besselink MG, Bollen TL, et al. Dutch Pancreatitis Study Group.Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA. 2012; 307:1053-106.