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Abstract

Statement of the Problem: Acute necrotic pancreatitis (ANP) remains complicated problem of urgent surgery because of high frequency of systemic, purulent and septic complications, mortality rate, which is in patients with infected pancreonecrosis 14.7-26.4%.

Purpose: The purpose of this study is to evaluate efficiency and establish indications for minimally invasive methods of treatment of post-necrotic pseudocyst of pancreas.

Methodology & Theoretical Orientation: For diagnostics ultrasonography was used, diagnostic laparoscopy, helical CT with contrast strengthening. Endoscopic interventions were applied by duodenoscopes 鈥淥lympus鈥� under control of X-ray machine 鈥淪iemens BV 300鈥�. Cystodigestive fistulas were created by prickly papilotoms. For providing of long passability of cystodigestive fistula were used two endoprostheses like 鈥減ig tail鈥� sized 10 Ft with length 5-6 cm. For transpapillary drainage were used pancreatic endoprostheses like 鈥減ig tail鈥�, sized 5-7 Ft with length 5 cm.

Findings: In 82 (68.2%) patients were applied minimally invasive methods of treatment; Percutaneous external drainage in 38 (46.3 %) patients, endoscopic transmural drainage of post-necrotic pseudocyst in 22 (26.85%) patients. Combined endoscopic interventions were applied in 22 (26.85%) patients. In particular, endoscopic transmural drainage with temporary stenting of pancreatic duct in 11 (50%) patients, endobiliary stenting with temporary stenting of pancreatic duct in 5 (22.7%) patients, temporary stenting of pancreatic duct in 4 (18.2%) patients, endoscopic transmural drainage with percutaneous external drainage in 2 (9.1%) patient.

Conclusion & Significance: Usage of combined minimally invasive methods of treatment of acute necrotic pancreatitis complicated by post-necrotic pseudocyst help to improve results of treatment, reduction of complications amount, contraction of stationary treatment terms and improving of life quality.

Recent Publications

1. Madacsy L, Kurucsai G and Joo I (2009) Rescue ERCP and insertion of small-calibre pancreatic stent to prevent the evolution of severe post-ERCP pancreatitis: a case-controlled series. Surg. Endosc. 23(8):1887-93.

2. Harewood G, Pochron N and Gostout C (2005) Prospective, randomized, controlled trial of prophylactic pancreatic stent placement for endoscopic snare excision of the duodenal ampulla. Gastrointest. Endosc. 62(3):367-70.

3. Bakker O, van Santvoort H and van Brunsshot S (2012) Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: randomized trial. J.A.M.A., 307(10):1053-61.

4. Banks P, Bollen T and Dervenis C (2012) Classification of acute pancreatitis 2012-revision of the Atlanta classification and definitions by international consensus. Gut. 62(1):102-11.

5. Lau S, Simchuk E and Kozarek R (2001) A pancreatic ductal leak should be sought to direct treatment in patients with acute pancreatitis. American Journal of Surgery, 181(5):411-5

Biography

Nazar Omelchuk works as an Abdominal Surgeon at Ivano-Frankivsk Regional Hospital and at Ivano-Frankivsk National Medical University. He is pursuing his PhD about minimally-invasive methods of acute pancreatic post-necrotic pseudocyst treatment. He has three registered patents about new ways of acute pancreatic post-necrotic pseudocyst treatment.

E-mail: dr.nazaromelchuk@gmail.com