HP06 *TRENDS IN THE MINIMALLY INVASIVE MANAGEMENT OF NECROTIZING PANCREATITIS: A SURVEY OF AUSTRALIAN AND NEW ZEALAND SURGEONS

Purpose:   Minimally invasive techniques to manage infected pancreatic necrosis have been recently developed, and changes in their pattern of use are not known. This study aimed to determine, in Australia and New Zealand the trends in the role of minimally invasive techniques to manage infected complications of necrotizing pancreatitis; and barriers to using minimally invasive necrosectomy. Methodology:   In 2007, members of the Australian and New Zealand Hepatic Pancreatic and Biliary Association were surveyed. Participant demographics and necrotizing pancreatitis caseload were determined. The role of percutaneous catheter drainage and minimally invasive necrosectomy in the management of pancreatic abscess, pseudocyst and necrosis were scored on Likert scales, comparing 2002 with 2007. Barriers to using minimally invasive necrosectomy were scored. Results:   The response rate was 49% (44/90). Between 2002 and 2007, percutaneous catheter drainage became more important as primary (p = 0.05) and secondary (p < 0.01) treatment for pancreatic abscess, and prior to minimally invasive necrosectomy for abscess, pseudocyst and necrosis (p < 0.01). Minimally invasive necrosectomy became increasingly important as primary treatment for infected necrosis (p < 0.01), and had been used by 47% of respondents. The greatest barriers to using minimally invasive necrosectomy were lack of training and experience, and the anatomical position and complexity of the target lesion. Conclusion:   Minimally invasive techniques are becoming increasingly important to manage pancreatic abscess, pseudocyst and necrosis. Further evidence is required to determine the best techniques for treating each form of infection associated with necrotizing pancreatitis.