Terapia de presión negativa combinada con tracción fascial mediante malla en el tratamiento de la necrosis pancreática infectada. Una nueva opción terapéutica

Background: Acute pancreatitis represents one of the most frequent digestive pathologies worldwide, which can be complicated as an infected necrotizing acute pancreatitis, that may require treatment with necrosectomy and open abdomen with the risk that this leads to the appearance of intestinal fistula and giant incisional hernias difficult to manage. Caso clinico: Mujer de 35 anos, intervenida de colecistectomia laparoscopica por colecistitis aguda, que es reingresada por ictericia y dolor abdominal 3 dias despues de su egreso hospitalario. Se realiza laparoscopia diagnostica, en la que se encuentra y drena un biliperitoneo de 3200 cc secundario a una fuga de munon del conducto cistico. Asi mismo, se practica una colangiopancreatografia retrograda endoscopica (CPRE), con extraccion de un lito biliar impactado en el coledoco distal. Presenta como complicacion del procedimiento pancreatitis aguda tras la CPRE con necrosis pancreatica infectada. Se realiza necrosectomia pancreatica abierta con sistema de presion negativa y traccion fascial mediante malla, logrando la resolucion del cuadro infeccioso con cierre definitivo de la cavidad abdominal sin presentar hernia incisional ni fistula intestinal posoperatoria. Conclusion: Patients with complicated acute pancreatitis with infected pancreatic necrosis represent a challenge in their treatment due to the serious nature of the condition and the morbidity associated with it. A therapeutic option is presented with the combined use of negative pressure therapy (ABThera™) and mesh-mediated fascial traction. With this report we propose a potential line of research to determine its role in the treatment of these patients, as well as their possible advantages and complications.