Surgical Transgastric Necrosectomy for Necrotizing Pancreatitis: A Single-stage Procedure for Walled-off Pancreatic Necrosis. Issue 1 (January 2020)

• Record Type: Journal Article
• Authors: Driedger, Michael; Zyromski, Nicholas J.; Visser, Brendan C.; Jester, Andrea; Sutherland, Francis R.; Nakeeb, Atilla; Dixon, Elijah; Dua, Monica M.; House, Michael G.; Worhunsky, David J.; Munene, Gitonga; Ball, Chad G.
• Is Part Of: Annals of surgery. Volume 271:Issue 1(2020)
• Publication Date: 2020-01
• Subjects: outcomes -- transgastric cystgastrostomy -- walled-off pancreatic necrosis -- WOPN; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000003048
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : Objective: The aim of this study was to evaluate the role of surgical transgastric necrosectomy (TGN) for walled-off pancreatic necrosis (WON) in selected patients. Background: WON is a common consequence of severe pancreatitis and typically occurs 3 to 5 weeks after the onset of acute pancreatitis. When symptomatic, it can require intervention. Methods: A retrospective review of patients with WON undergoing surgical management at 3 high-volume pancreatic institutions was performed. Surgical indications, intervention timing, technical methodology, and patient outcomes were evaluated. Patients undergoing intervention <30 days were excluded. Differences across centers were evaluated using a P value of <0.05 as significant. Results: One hundred seventy-eight total patients were analyzed (mean WON diameter = 14 cm, 64% male, mean age = 51 years) across 3 centers. The majority required inpatient admission with a median preoperative length of hospital stay of 29 days (25% required preoperative critical care support). Most (96%) patients underwent a TGN. The median duration of time between the onset of pancreatitis symptoms and operative intervention was 60 days. Thirty-nine percent of the necrosum was infected. Postoperative morbidity and mortality were 38% and 2%, respectively. The median postoperative length of hospital length of stay was 8 days, with the majority of patients discharged home. The median length of follow-up was 21 months, with 91% of patients having complete clinical resolution of symptoms at a median of 6 weeks. Readmission to hospital and/or a repeat intervention was also not infrequent (20%). Conclusion: Surgical TGN is an excellent 1-stage surgical option for symptomatic WON in a highly selected group of patients. Precise surgical technique and long-term outpatient follow-up are mandatory for optimal patient outcomes.