Combined videoendoscopic-transcutaneous approach in surgical treatment of the infected acute necrotic pancreatitis

Keywords: іnfected acute necrotic pancreatitis; miniinvasive interventions; еcho-videoendoscopy

Abstract

Objective. To estimate the efficacy of the proposed combined videoendoscopic transcutaneous access in surgical treatment of the infected acute necrotic pancreatitis.

Маterials and methods. Transcutaneous diapeutic punctures and draining were applied in 74 patients (control group), and in 23 (main group) for treatment of spread infected pathological foci, using combined videothoracoscoopic transcutaneous access.

Results. Application of diapeutic interventions have permitted to defer the operative intervention performance up to 25 - 30-th day of the disease in all patients of the main group and in 82.7% – in a control one. In the main group a reduction of necessity in laparotomic necrsequestrectomy performance by 29.1%, of the invasive interventions – by 46.1%, and for mortality rate – by 2.9% was noted.

Conclusion. Application of combined access have guaranteed the reduction of the invasive interventions performance rate, including laparotomic necrsequestrectomy.

Author Biographies

І. V. Khomyak, Shalimov National Institute of Surgery and Transplantology, Kyiv

Khomiak Igor Vasylovych - MD, PhD, Professor,
Head Scientific Researcher of Department of Pancreas Surgery and Bile Ducts Reconstruction Surgery,
A.A. Shalimov National Institute of Surgery and Transplantology,
Kyiv, 30 Heroyv Sevastopolya Str., 03680,
+38(044) 497 13 74
md.khomiak@gmail.commd.khomiak@gmail.com

М. V. Коstylev, Shalimov National Institute of Surgery and Transplantology, Kyiv

Kostyliev Mykhailo Volodymyrovych - MD, PhD, Professor,
Head of Department of Radiation and Functional Diagnosis, A. Shalimov National Institute of Surgery and Transplantology,
Kyiv, 30 Heroyv Sevastopolya Str., 03680
+38(044) 497 13 74
mvk.via@gmail.com

О. V. Rotar, Bukovyna State Medical University, Chernivtsi

Rotar Oleksandr Vasylovych – MD, PhD, Associate Professor
Department of General Surgery,
Bukovinian State Medical University
2 Teatralna Sq., 58000,
oleksandr.rotar@gmail.com

І. S. Теreshkevych, Shalimov National Institute of Surgery and Transplantology, Kyiv

Tereshkevich Ivan Stepanovych – MD, PhD,  Senior Scientific Researcher
Laboratory of Interventional Endoscopy, A. Shalimov National Institute of Surgery and Transplantology,
Kyiv, 30 Heroyv Sevastopolya Str., 03680,
tis_v@ukr.ne

V. І. Rotar, Bukovyna State Medical University, Chernivtsi

Rotar Vasyl Ivanovych – MD, PhD, Associate Professor
Department of Anesthesiology and Reanimatology,
Bukovinian State Medical University,
2 Teatralna Sq., 58000,
rotar.v@i.ua 

А. І. Khomyak, Shalimov National Institute of Surgery and Transplantology, Kyiv

Khomiak Andrii Igorovich - MD, Scientific Researcher
Department of Pancreas Surgery and Bile Ducts Reconstruction Surgery, A. Shalimov National Institute of Surgery and Transplantology,
Kyiv, 30 Heroyv Sevastopolya Str., 03680,
kh.ndrew@gmail.com 

References

1. Peery AF, Dellon ES, Lund J, Crockett SD, McGowan CE, Bulsiewicz WJ, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012 Nov;143(5):1179-87.

2. Phillip V, Steiner JM, Algül H. Early phase of acute pancreatitis: assessment and management. World J Gastrointest Pathophys. 2014 May; 5(3):158-64.

3. 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.

4. 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.

5. 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.

6. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013 Jun;13 suppl. 1:1-15.

7. 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.

8. 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.

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.

10. Khomiak IV, Rotar OV, Tereshkevych IS, Rotar VI, Khomiak AI, Taneja KS. Comparison of open pancreatic necrosectomy with step-up minimally invasive approach as surgical treatment of patients with acute necrotizing pancreatitis. Int Surg J. 2017 Aug;4(8):2502-6.
Published
2018-01-28
Section
General Problems of Surgery