Abstract
Guidelines advocate minimally invasive drainage rather than open surgery for infected pancreatic necrosis (IPN) after acute pancreatitis. We hypothesized that the conservative approach could be extended even further by treating patients using an antibiotics-only protocol. Between June 2009 and July 2017, patients with IPN were selectively managed with carbapenem antibiotics for a minimum of 6 weeks. We compared these patients with patients who underwent minimal access retroperitoneal pancreatic necrosectomy (MARPN) for IPN to identify characteristics of this patient group. Of 33 patients with radiologically proven IPN, 13 patients received antibiotics without any surgical or radiological intervention and resulted in no disease-specific mortality and one case of pancreatic insufficiency. In comparison, 44 patients underwent MARPN with a mortality of 20%, and 81.8% developed pancreatic insufficiency. The modified Glasgow score and computed tomography severity score was less in the antibiotic-only group (P<0.001 and P=0.014, respectively). Patients who underwent MARPN had lower serum haemoglobin and albumin levels (P=0.030 and 0.001, respectively), and a higher C-reactive protein (P=0.027). Conservative treatment of IPN with antib...Continue Reading
References
Dec 1, 1992·Gastroenterology·M BüchlerH G Beger
Dec 1, 1984·Gut·S L BlameyD C Carter
Feb 1, 1984·Journal of Clinical Pathology·A D MayerE H Cooper
Feb 1, 1993·The British Journal of Surgery·A L Widdison, N D Karanjia
Feb 1, 1997·European Journal of Gastroenterology & Hepatology·M Larvin
Jun 6, 2003·Digestive Surgery·H RameshA Venugopal
Oct 27, 2004·AJR. American Journal of Roentgenology·Koenraad J MorteleStuart G Silverman
Oct 29, 2005·Clinics·Enio Campos AmicoDanilo Vendrame Vivas
Feb 8, 2006·Journal of Hepato-biliary-pancreatic Surgery·Shuji IsajiUNKNOWN JPN
Apr 21, 2007·Pancreas·Jun Kyu LeeYong Bum Yoon
May 10, 2007·Drugs·George G ZhanelJames A Karlowsky
Dec 19, 2007·Archives of Surgery·Marc G H BesselinkHein G Gooszen
Apr 23, 2010·The New England Journal of Medicine·Hjalmar C van SantvoortUNKNOWN Dutch Pancreatitis Study Group
Jun 15, 2010·Gastroenterology·Maxim S PetrovJohn A Windsor
Feb 6, 2010·World Journal of Gastrointestinal Pharmacology and Therapeutics·Mónica García, José Julián Calvo
Jul 12, 2011·Gastroenterology·Hjalmar C van SantvoortUNKNOWN Dutch Pancreatitis Study Group
Oct 27, 2012·Gut·Peter A BanksUNKNOWN Acute Pancreatitis Classification Working Group
Sep 27, 2013·Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]·UNKNOWN Working Group IAP/APA Acute Pancreatitis Guidelines
Jun 17, 2014·American Journal of Surgery·Blair A WormerB Todd Heniford
Dec 5, 2014·World Journal of Gastroenterology : WJG·George KokosisTheodore N Pappas
Feb 24, 2016·JAMA : the Journal of the American Medical Association·Mervyn SingerDerek C Angus
Mar 9, 2017·Clinics·Roberto RasslanEdivaldo Massazo Utiyama