Technical aspects of minimally invasive percutaneous approach for local complications of acute pancreatitis

Abstract

Aim. To improve the results of treatment for patients with acute pancreatitis by optimizing the technique of performing percutaneous methods of drainage and sequestrectomy.Material and methods. We have considered experience of treating pancreatic necrosis in 257 patients, confirmed by computed tomography, intraoperatively, and postmortem examinations. Moderate severity pancreatitis was detected in 159 (61.9%) patients, severe – in 98 (38.1%) cases.Results. Small focal pancreatic necrosis was detected in 99 (62.3%) patients with moderate pancreatitis, large focal pancreatitis – in 60 (37.7%). Small-focal pancreatic necrosis was in 23 (23.5%) patients, large-focal – in 43 (43.9%), subtotal – in 29 (29.6%), total – in 3 (3.1%) among patients with severe acute pancreatitis. Percutaneous approach was used in combination with transluminal and open surgery in 59 (23%) patients. Infected necrosis was detected in 6 (3.8%) patients with acute moderate pancreatitis and in 44 (44.9%) patients with severe pancreatitis, sepsis – in 12 (12.2%) patients. 27 (10.5%) patient have died from septic shock in the first phase of pancreatitis, included 14 (5.4%) cases after surgery. Overall 41 (16%) patients with pancreatic necrosis have died.Conclusion. Compliance of stages in surgical treatment technology allows optimally combine it with transluminal sequestrectomy, reduces surgical trauma, eliminates additional risks of open approach associated with complications and deaths.