Open Pancreatic Debridement in Necrotizing Pancreatitis
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MULTIMEDIA ARTICLE
Open Pancreatic Debridement in Necrotizing Pancreatitis Thomas K. Maatman 1 & Nicholas J. Zyromski 1 Received: 29 April 2020 / Accepted: 30 June 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Introduction The modern era of intervention in necrotizing pancreatitis (NP) has seen a significant paradigm shift toward minimally invasive approaches as initial therapy. Methods This video outlines the critical steps of OPD for NP. Results A 69-year-old female with acute biliary NP underwent OPD for NP after 12-weeks of medical management. Her postoperative course was uncomplicated, and she was discharged home on postoperative day seven. The patient recovered uneventfully. Conclusion Operative pancreatic debridement (OPD), now considered the final step in the modern treatment algorithm of NP, remains an important treatment strategy in NP. Keywords Pancreatitis . Acute necrotizing . Pancreatic debridement . Necrosectomy . Operative technique
In recent years, the management of necrotizing pancreatitis (NP) patients requiring intervention has seen a significant paradigm shift favoring minimally invasive approaches as initial therapy.1–3 Open pancreatic debridement (OPD) is now considered the final step in the modern treatment algorithm of NP.4,5 While minimally invasive approaches offer definitive treatment in select NP patients, a significant proportion of patients that will require OPD remain.1,2,6–10 This video outlines the critical steps of open pancreatic debridement for necrotizing pancreatitis. A 69-year-old female developed acute biliary NP involving greater than 50% of the gland. She was initially managed medically and discharged home with nasojejunal tube feeds after a 2-week hospital stay. During the ensuing 12-week follow-up, This work has been presented as a poster presentation at the 2020 annual meeting of the Americas Hepato-Pancreato-Biliary Association in Miami, FL. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11605-020-04732-1) contains supplementary material, which is available to authorized users. * Nicholas J. Zyromski [email protected] Thomas K. Maatman [email protected] 1
Department of Surgery, Indiana University School of Medicine, 545 Barnhill Dr., EH 519, Indianapolis, IN 46202, USA
the patient experienced symptomatic necrosis and significant weight loss (~ 130 lbs). Endoscopic ultrasound was performed; however, the necrosis was 95% solid and deemed unamenable to transgastric stenting with debridement. The patient underwent OPD, distal pancreatectomy, cholecystectomy, and placement gastrojejunostomy feeding tube 14 weeks after NP onset. Her postoperative course was uncomplicated, and she was discharged home on postoperative day 7 tolerating tube feeds. At 1-month follow-up, the patient was asymptomatic, tolerating oral diet and supplemental tube feeds, and demonstrated significant improvement in nutritional parameters. This video highlights that open pancreatic debridement remains an important tool for surgeo
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