Year 2014 Vol. 22 No 1

GENERAL AND SPECIAL SURGERY

V.N. CHERNOV, B.M. BELIK, A.Z. ALIBEKOV

TREATMENT OF THE INFECTED FORMS OF ACUTE DESTRUCTIVE PANCREATITIS USING MINIMALLY INVASIVE TECHNOLOGIES

SBEE HPE “Rostov State Medical University”,
The Russian Federation

Objectives. To determine the role and estimate clinical efficiency of minimally invasive interventions in treatment of patients with the infected forms of the acute destructive pancreatitis (ADP).
Methods. The study included 167 patients with infected forms of ADP, 48 (28,7%) patients underwent minimally invasive interventions. In 32 patients by ultrasonically guided percutaneous puncture and drainage interventions (PPDI) have been performed, in 3 patients – under video laparoscopic control, 6 patients underwent necrosectomy by video laparoscopy and/or retroperitoneosopy and 7 patients underwent necrosectomy from mini approaches with application of set “mini-Assistant”. The choice of a minimally invasive method was defined strictly individually taking into account the character, volume and localization of a purulent cavity, the sizes of sequesters, the ratio of fluidic and tissue components, and also initial severity of a patient condition according to SAPS scale.
Results. From 48 patients with the infected forms of ADP who were subjected to minimally invasive interventions, a positive clinical effect was obtained in 41 (85,4%) patients. In these patients minimally invasive interventions appeared to be the final surgical manipulation. In 7 (14,6%) cases after the minimally invasive interventions application the further traditional surgical treatment was considered to be necessary. The postoperative lethality in the group of patients with the infected forms of ADP, who were subjected to the minimally invasive interventions, made up 12,5%.
Conclusions. Minimally invasive intervention is considered to be the effective methods of surgical treatment of patients with the infected forms of ADP with obligatory careful selection of patients and a strict individual approach to the choice of operation.

Keywords: pancreatonecrosis, minimally invasive surgery, transcutaneous drainage, necrosectomy
p. 63 – 67 of the original issue
References
  1. Savel'ev VS, Filimonov MI, Burnevich SZ. Pankreonekrozy [Pancreatonecrosis]. Moscow, RF: MIA; 2008. 264.
  2. Eriukhin IA, Gel'fand BR, Shliapnikov SA, red. Khirurgicheskie infektsii [Surgical infections]: prakt ruk. 2-e izd pererab i dop. Moscow, RF: Litterra; 2006. 736 p.
  3. Savel'ev VS. Klinicheskaia khirurgiia: natsional'noe rukovodstvo [Clinical surgery: national guidance]: Savel'ev BC, Kirienko AI, red. Moscow, RF: GEOTAR-Media; 2008-2009; 1-2. p. 864, 832.
  4. Forsmark C E. Pancreatitis and its complications. New Jersey: Humana Press Inc., 2005. 349 p.
  5. Volkov AN. Ostryi pankreatit i ego oslozhneniia [Acute pancreatitis and its complications]. Cheboksary, RF: Izd-vo Chuvash un-ta; 2009. 175.
  6. Bradley EL 3rd, Dexter ND. Management of severe acute pancreatitis: a surgical odyssey. Ann Surg. 2010 Jan;251(1):6–17.
  7. Beger HG, Isenmann R. Acute pancreatitis: who needs an operation? J Hepatobiliary Pancreat Surg. 2002;9(4):436–42.
  8. Prudkov MI, Shulutko AM, red. Galimzianov FV, Levit AL, Kovalevskii AD, Alferov SIu. Minimal'no invazivnaia khirurgiia nekrotiziruiushchego pankreatita [Minimally invasive surgery of necrotizing pancreatitis]. Posobie dlia vrachei. Ekaterinburg, RF; 2001. p. 47.
  9. Loveday BP, Mittal A, Phillips A, Windsor JA. Minimally invasive management of pancreatic abscess, pseudocyst, and necrosis: a systematic review of current guidelines. World J Surg. 2008 Nov;32(11):2383-94.
  10. Sahakian AB, Krishnamoorthy S, Taddei TH. Necrotizing pancreatitis complicated by fistula and upper gastrointestinal hemorrhage. Clin Gastroenterol Hepatol. 2011 Jul;9(7): e66–7.
  11. Tonsi AF, Bacchion M, Crippa S, Malleo G, Bassi C. Acute pancreatitis at the beginning of the 21st century: the state of the art. World J Gastroenterol. 2009 Jun 28;15(24):2945-59.
  12. Balnykov SI. Chreskozhnye vmeshatel'stva pod kontrolem UZI u bol'nykh pankreaonekrozom [Percutaneous ultrasound-guided intervention in patients with necrotizing pancreatitis]. Med Vizualizatsiia. 2010;(2):104–08.
  13. Carter R. Percutaneous management of necrotizing pancreatitis. HPB (Oxford). 2007(3) 9:235–39.
  14. Gel'fand BR, Burnevich SZ, Brazhnik TB, Sergeeva NA. Novoe v diagnostike infektsionnykh oslozhnenii i sepsisa v khirurgii: rol' opredeleniia prokal'tsitonina [New in the diagnosis of infectious complications and sepsis in surgery: the role of determining procalcitonin]. Infektsii v Khirurgii. 2003;(1):8–13.
  15. Istomin NP, Belov IN, Egorov MS, Agapov KV, Dzugkoeva FA. Primenenie lechebno-diagnosticheskogo algoritma dlia opredeleniia khirurgicheskoi taktiki u bol'nykh s pankreonekrozom [Application of diagnostic and treatment algorithm for determining the surgical approach in patients with necrotizing pancreatitis]. Khirurg. 2010;7:6–13.
Address for correspondence:
344000, Rossiiskaia Federatsiia, g. Rostov-na-Donu, per. Nakhichevanskii, d. 29, GBOU VPO «Rostovskii gosudarstvennyi meditsinskii universitet», kafedra obshchei khirurgii,
e-mail: xupypr@doctor.com,
Alibekov Albert Zaurbekovich
Information about the authors:
Chernov V.N. MD, an Honored Scientist of RF, professor, a head of the general surgery chair of SBEE HPE “Rostov State Medical University”.
Belik B.M. MD, professor the general surgery chair of SBEE HPE “Rostov State Medical University”.
Alibekov A.Z. A post-graduate student of the general surgery chair of SBEE HPE “Rostov State Medical University”.
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