J Mier1, E L León, A Castillo, F Robledo, R Blanco. 1. Department of General and Gastrointestinal Surgery, Hospital de Especialidades, Centro Médico Nacional Siglo XXI (IMSS), Mexico City, Mexico.
Abstract
BACKGROUND: Debate as to whether surgery in severe necrotizing pancreatitis (SNP) should be done early or late has been present ever since the disease was described. There are no prospective, randomized studies addressing this specific issue. METHODS:Patients with SNP, documented clinically, with Ranson's criteria, and dynamic pancreatography (DP) findings were randomly allocated in two groups for treatment. Group A included early necrosectomy (within 48 to 72 hours of onset) and group B, late necrosectomy (at least 12 days after onset). Both groups continued with open packing and staged necrosectomies. Cultures were obtained at each laparotomy and necrosis was verified histologically in all instances. RESULTS: During a 36-month study period, 150 patients with unequivocal acute pancreatitis were admitted for treatment. Forty-one with SNP initially entered the study; there were 5 drop outs. Patients in group A (25) and group B (11) had no difference in distribution by gender or mean age, etiology, mean Ranson's signs (4 versus 3.8), DP findings, rate of infected necrosis, or necrosectomies required per patient. Although the mortality rate (58% versus 27%) did not reach statistical significance, the odds ratio for mortality was 3.4 times higher in group A, which made us finish the study. CONCLUSION: This prospective, randomized study from a single institution clearly demonstrates that early intensive conservative treatment with late necrosectomy for selected cases is the current rationale approach for SNP.
RCT Entities:
BACKGROUND: Debate as to whether surgery in severe necrotizing pancreatitis (SNP) should be done early or late has been present ever since the disease was described. There are no prospective, randomized studies addressing this specific issue. METHODS:Patients with SNP, documented clinically, with Ranson's criteria, and dynamic pancreatography (DP) findings were randomly allocated in two groups for treatment. Group A included early necrosectomy (within 48 to 72 hours of onset) and group B, late necrosectomy (at least 12 days after onset). Both groups continued with open packing and staged necrosectomies. Cultures were obtained at each laparotomy and necrosis was verified histologically in all instances. RESULTS: During a 36-month study period, 150 patients with unequivocal acute pancreatitis were admitted for treatment. Forty-one with SNP initially entered the study; there were 5 drop outs. Patients in group A (25) and group B (11) had no difference in distribution by gender or mean age, etiology, mean Ranson's signs (4 versus 3.8), DP findings, rate of infected necrosis, or necrosectomies required per patient. Although the mortality rate (58% versus 27%) did not reach statistical significance, the odds ratio for mortality was 3.4 times higher in group A, which made us finish the study. CONCLUSION: This prospective, randomized study from a single institution clearly demonstrates that early intensive conservative treatment with late necrosectomy for selected cases is the current rationale approach for SNP.
Authors: Ebby Simon; A J Joseph; Lisa Choudhrie; Anu Eapen; Frederick Vyas; V Sitaram; B S Ramakrishna; Ashok Chacko Journal: Indian J Gastroenterol Date: 2010-01
Authors: Hjalmar C van Santvoort; Marc G Besselink; Thomas L Bollen; Erik Buskens; Bert van Ramshorst; Hein G Gooszen Journal: World J Surg Date: 2007-06-16 Impact factor: 3.352
Authors: Janneke van Grinsven; Sandra van Brunschot; Mark C van Baal; Marc G Besselink; Paul Fockens; Harry van Goor; Hjalmar C van Santvoort; Thomas L Bollen Journal: J Gastrointest Surg Date: 2018-05-11 Impact factor: 3.452
Authors: Mohamed Abdelhafez; Mayada Elnegouly; M S Hasab Allah; Mostafa Elshazli; Hany M S Mikhail; Ayman Yosry Journal: Surg Endosc Date: 2013-04-13 Impact factor: 4.584
Authors: Janneke van Grinsven; Hjalmar C van Santvoort; Marja A Boermeester; Cornelis H Dejong; Casper H van Eijck; Paul Fockens; Marc G Besselink Journal: Nat Rev Gastroenterol Hepatol Date: 2016-03-09 Impact factor: 46.802