Retroperitoneal versus open intraperitoneal necrosectomy in step-up therapy for infected necrotizing pancreatitis: A meta-analysis. (August 2018)

• Record Type: Journal Article
• Authors: Wang, Yun-Bing; Yang, Xiao-Li; Chen, Long; Chen, Zheng-Ju; Miao, Chun-Mu; Xia, Jin
• Is Part Of: International journal of surgery. Volume 56(2018)
• Page Start: 83
• Page End: 93
• Publication Date: 2018-08
• Subjects: Retroperitoneal approach -- Open intraperitoneal approach -- Necrosectomy -- Step-up therapy -- Infected necrotizing pancreatitis -- Meta-analysis; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2018.06.012
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Background: Step-up therapy is the recommended therapy for infected necrotizing pancreatitis (INP). However, the most appropriate secondary therapy for use after initial drainage has not been fully determined. This meta-analysis was designed to evaluate the efficacy and safety of retroperitoneal versus open intraperitoneal necrosectomy as part of a step-up strategy for INP. Materials and methods: Eight online databases were searched for randomized controlled trials (RCTs) and cohorts comparing retroperitoneal and open intraperitoneal step-up approaches for treating INP. The data was pooled with a random-effects model. Results: A total of 21 controlled studies (one RCT and twenty cohorts) and 2177 patients were included in this study. Our meta-analysis showed that the retroperitoneal group had a lower postoperative complication rate [risk ratio (RR) = 0.575, 95% confidence interval (CI) = 0.459 to 0.719, P < 0.001], lower postoperative mortality (RR = 0.525, 95% CI = 0.430 to 0.642, P < 0.001), higher technical success rate (RR = 1.313, 95% CI = 1.017 to 1.694, P = 0.037), similar surgical reintervention rate (RR = 0.930, 95% CI = 0.783 to 1.106, P = 0.411), shorter operative time [standardized mean difference (SMD) = −2.402, 95% CI = −3.642 to −1.161, P < 0.001], and shorter hospital stay (SMD = −2.034, 95% CI = −3.041 to −1.026, P < 0.001) than the open group. These results were supported by a subgroup analysis. Conclusion: For treating INP, the retroperitoneal approach is safer and more effective than the open intraperitoneal approach. Highlights: Step-up therapy is the recommended therapy for infected necrotizing pancreatitis (INP). However, the most appropriate secondary therapy for use after initial drainage has not been fully determined. We searched for studies comparing retroperitoneal and open intraperitoneal step-up approaches for treating INP. A total of 21 controlled studies and 2177 patients were included. For treating INP, the retroperitoneal approach is safer and more effective than the open intraperitoneal approach.