Necrotizing acute pancreatitis current status - emerging new strategies in surgical management.
2012
Despite that pancreatic necrosis complicates only 15 % of cases of acute pancreatitis (AP), it is associated with
high morbidity and considerable mortality. In an attempt to improve prognosis, many surgical strategies have been described
during the last few decades. Currently, necrosectomy remains the cornerstone in the surgical treatment of infected
pancreatic necrosis and in selected cases of sterile necrotizing pancreatitis. Following necrosectomy, continuous closed
lavage is recommended by many authors, while closed abdominal packing /drainage and repeated planned necrosectomies-
commonly using the zipper technique-are also acceptable alternative strategies. Open abdomen (laparostomy) is
rarely indicated in carefully selected cases (typically in abdominal compartment syndrome associated with necrotizing
AP). During the last decade, minimally invasive techniques (including percutaneous drainage, retroperitoneal endoscopic
approach, transgastric endoscopic approach etc) have been extensively studied by some groups not only in the management
of pancreatic abscesses and / or pseudocysts, but also as primary methods of treatment of necrotizing AP. Results
have been impressive, but experience currently is limited to only a few centers around the world.
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