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<meta property="og:title" content="Surgical Versus Nonsurgical Treatment of Infected Pancreatic Necrosis: More Arguments to Change the Paradigm" /> <meta property="og:image" content="http://a.academia-assets.com/images/open-graph-icons/fb-paper.gif" /> <meta property="og:description" content="Objectives This study aimed to compare primary surgical versus nonsurgical treatment in a series of patients with infected pancreatic necrosis (IPN) and to investigate whether the success of nonsurgical approach is related to a less severe disease." /> <meta property="article:author" content="https://independent.academia.edu/CalveteJulio" /> <meta name="description" content="Objectives This study aimed to compare primary surgical versus nonsurgical treatment in a series of patients with infected pancreatic necrosis (IPN) and to investigate whether the success of nonsurgical approach is related to a less severe disease." /> <title>(PDF) Surgical vs Nonsurgical Treatments for IPN</title> <link 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window.loswp.showSignupCaptcha = false window.loswp.willEdgeCache = false; window.loswp.work = {"work":{"id":111221864,"created_at":"2023-12-12T02:22:23.731-08:00","from_world_paper_id":245543155,"updated_at":"2025-01-31T19:53:07.052-08:00","_data":{"publisher":"Springer Science and Business Media LLC","ai_title_tag":"Surgical vs Nonsurgical Treatments for IPN","grobid_abstract":"Objectives This study aimed to compare primary surgical versus nonsurgical treatment in a series of patients with infected pancreatic necrosis (IPN) and to investigate whether the success of nonsurgical approach is related to a less severe disease. Methods Thirty-nine consecutive patients with IPN have been included and further subdivided into two groups: primary surgical (n=21) versus nonsurgical (n=18). Outcome measures were the differences in mortality, morbidity, and pancreatic function. Comorbidity, organ failure, and other severity indexes were compared between the two groups. Results Mortality occurred in 16.7 % of cases in the nonsurgical group versus 42.9 % in the surgical group. In the primary nonsurgical group, seven were operated on due to failure of initial conservative treatment. In this latter group, mortality was 28.6 % and was performed significantly later than in the primary surgical group. The group of primary surgical treatment was associated with a significant higher rate of multiple organ failure (MOF) at IPN diagnosis, new onset or worsening of organ failure, and MOF and nosocomial infection after surgery. Conclusions Initial nonsurgical approach in IPN is associated with better results both in cases which respond to this treatment as well as in those who, failing this conservative approach, have to be operated on after a delayed period. Primary surgically treated patients had a more severe disease at the time of IPN.","publication_date":"2013,,","publication_name":"Journal of Gastrointestinal Surgery","grobid_abstract_attachment_id":"108816401"},"document_type":"paper","pre_hit_view_count_baseline":null,"quality":"high","language":"en","title":"Surgical Versus Nonsurgical Treatment of Infected Pancreatic Necrosis: More Arguments to Change the Paradigm","broadcastable":true,"draft":null,"has_indexable_attachment":true,"indexable":true}}["work"]; window.loswp.workCoauthors = [291475203]; window.loswp.locale = "en"; window.loswp.countryCode = "SG"; window.loswp.cwvAbTestBucket = ""; window.loswp.designVariant = "ds_vanilla"; window.loswp.fullPageMobileSutdModalVariant = "control"; window.loswp.useOptimizedScribd4genScript = false; window.loginModal = {}; window.loginModal.appleClientId = 'edu.academia.applesignon'; window.userInChina = "false";</script><script defer="" src="https://accounts.google.com/gsi/client"></script><div class="ds-loswp-container"><div class="ds-work-card--grid-container"><div class="ds-work-card--container js-loswp-work-card"><div class="ds-work-card--cover"><div class="ds-work-cover--wrapper"><div class="ds-work-cover--container"><button class="ds-work-cover--clickable js-swp-download-button" data-signup-modal="{"location":"swp-splash-paper-cover","attachmentId":108816401,"attachmentType":"pdf"}"><img alt="First page of “Surgical Versus Nonsurgical Treatment of Infected Pancreatic Necrosis: More Arguments to Change the Paradigm”" class="ds-work-cover--cover-thumbnail" src="https://0.academia-photos.com/attachment_thumbnails/108816401/mini_magick20231212-1-ushwye.png?1702376672" /><img alt="PDF Icon" class="ds-work-cover--file-icon" src="//a.academia-assets.com/images/single_work_splash/adobe_icon.svg" /><div class="ds-work-cover--hover-container"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span><p>Download Free PDF</p></div><div class="ds-work-cover--ribbon-container">Download Free PDF</div><div class="ds-work-cover--ribbon-triangle"></div></button></div></div></div><div class="ds-work-card--work-information"><h1 class="ds-work-card--work-title">Surgical Versus Nonsurgical Treatment of Infected Pancreatic Necrosis: More Arguments to Change the Paradigm</h1><div class="ds-work-card--work-authors ds-work-card--detail"><a class="ds-work-card--author js-wsj-grid-card-author ds2-5-body-md ds2-5-body-link" data-author-id="291475203" href="https://independent.academia.edu/CalveteJulio"><img alt="Profile image of Julio Calvete" class="ds-work-card--author-avatar" src="https://0.academia-photos.com/291475203/138389369/127858114/s65_julio.calvete.png" />Julio Calvete</a></div><div class="ds-work-card--detail"><p class="ds-work-card--detail ds2-5-body-sm">2013, Journal of Gastrointestinal Surgery</p><div class="ds-work-card--work-metadata"><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">visibility</span><p class="ds2-5-body-sm" id="work-metadata-view-count">…</p></div><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">description</span><p class="ds2-5-body-sm">7 pages</p></div><div class="ds-work-card--work-metadata__stat"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">link</span><p class="ds2-5-body-sm">1 file</p></div></div><script>(async () => { const workId = 111221864; 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if (!viewCountBody) { throw new Error('Failed to find work views element'); } viewCountBody.textContent = `${commaizedViewCount} views`; } catch (error) { // Remove the whole views element if there was some issue parsing. document.getElementById('work-metadata-view-count')?.parentNode?.remove(); throw new Error(`Failed to parse view count: ${viewCount}`, error); } }; // If the DOM is still loading, wait for it to be ready before updating the view count. if (document.readyState === "loading") { document.addEventListener('DOMContentLoaded', () => { updateViewCount(viewCount); }); // Otherwise, just update it immediately. } else { updateViewCount(viewCount); } })();</script></div><p class="ds-work-card--work-abstract ds-work-card--detail ds2-5-body-md">Objectives This study aimed to compare primary surgical versus nonsurgical treatment in a series of patients with infected pancreatic necrosis (IPN) and to investigate whether the success of nonsurgical approach is related to a less severe disease. Methods Thirty-nine consecutive patients with IPN have been included and further subdivided into two groups: primary surgical (n=21) versus nonsurgical (n=18). Outcome measures were the differences in mortality, morbidity, and pancreatic function. Comorbidity, organ failure, and other severity indexes were compared between the two groups. Results Mortality occurred in 16.7 % of cases in the nonsurgical group versus 42.9 % in the surgical group. In the primary nonsurgical group, seven were operated on due to failure of initial conservative treatment. In this latter group, mortality was 28.6 % and was performed significantly later than in the primary surgical group. The group of primary surgical treatment was associated with a significant higher rate of multiple organ failure (MOF) at IPN diagnosis, new onset or worsening of organ failure, and MOF and nosocomial infection after surgery. Conclusions Initial nonsurgical approach in IPN is associated with better results both in cases which respond to this treatment as well as in those who, failing this conservative approach, have to be operated on after a delayed period. Primary surgically treated patients had a more severe disease at the time of IPN.</p><div class="ds-work-card--button-container"><button class="ds2-5-button js-swp-download-button" data-signup-modal="{"location":"continue-reading-button--work-card","attachmentId":108816401,"attachmentType":"pdf","workUrl":"https://www.academia.edu/111221864/Surgical_Versus_Nonsurgical_Treatment_of_Infected_Pancreatic_Necrosis_More_Arguments_to_Change_the_Paradigm"}">See full PDF</button><button class="ds2-5-button ds2-5-button--secondary js-swp-download-button" data-signup-modal="{"location":"download-pdf-button--work-card","attachmentId":108816401,"attachmentType":"pdf","workUrl":"https://www.academia.edu/111221864/Surgical_Versus_Nonsurgical_Treatment_of_Infected_Pancreatic_Necrosis_More_Arguments_to_Change_the_Paradigm"}"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span>Download PDF</button></div><div class="ds-signup-banner-trigger-container"><div class="ds-signup-banner-trigger ds-signup-banner-trigger-control"></div></div><div class="ds-signup-banner ds-signup-banner-control"><div id="ds-signup-banner-close-button"><button class="ds2-5-button ds2-5-button--secondary ds2-5-button--inverse"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">close</span></button></div><div class="ds-signup-banner-ctas"><img src="//a.academia-assets.com/images/academia-logo-capital-white.svg" /><h4 class="ds2-5-heading-serif-sm">Sign up for access to the world's latest research</h4><button class="ds2-5-button ds2-5-button--inverse ds2-5-button--full-width js-swp-download-button" data-signup-modal="{"location":"signup-banner"}">Sign up for free<span class="material-symbols-outlined" style="font-size: 20px" translate="no">arrow_forward</span></button></div><div class="ds-signup-banner-divider"></div><div class="ds-signup-banner-reasons"><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Get notified about relevant papers</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Save papers to use in your research</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Join the discussion with peers</span></div><div class="ds-signup-banner-reasons-item"><span class="material-symbols-outlined" style="font-size: 24px" translate="no">check</span><span>Track your impact</span></div></div></div><script>(() => { // Set up signup banner show/hide behavior: // 1. 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The purpose of this study is to identify changes in morbidity and mortality rates as our methods of surgical management have evolved. One hundred two consecutive patients (59 males and 43 females, mean age 53 ± 16 years) with PN managed surgically were classified as group I (1993–2001), after the routine use of prophylactic antibiotics (N = 55), and group II (2002–2005), after the use of International Association of Pancreatology (IAP) guidelines for intervention (N = 47). Age, sex, etiology of pancreatitis, percent of necrosis, infected necrosis, and acute physiology and chronic health evaluation II scores were similar between groups. Despite a significant worsening of Balthazar computed tomography scoring in group II patients (p p = 0.03), mortality (10 [18%] vs 2 [4%], p = 0.03), and hospital length of stay (38 ± 33 days vs 26 ± 23 days, p = 0.04) were significantly less in group II patients. Current methods of surgical management utilizing IAP guidelines have resulted in a decreased operative morbidity, mortality, and hospital length of stay in patients with PN.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Declining Morbidity and Mortality Rates in the Surgical Management of Pancreatic Necrosis","attachmentId":47778517,"attachmentType":"pdf","work_url":"https://www.academia.edu/9442292/Declining_Morbidity_and_Mortality_Rates_in_the_Surgical_Management_of_Pancreatic_Necrosis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/9442292/Declining_Morbidity_and_Mortality_Rates_in_the_Surgical_Management_of_Pancreatic_Necrosis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="1" data-entity-id="115571335" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/115571335/Can_infected_pancreatic_necrosis_really_be_managed_conservatively">Can infected pancreatic necrosis really be managed conservatively?</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="301339203" href="https://independent.academia.edu/AliAlsarira">Ali Al-sarira</a></div><p class="ds-related-work--metadata ds2-5-body-xs">European journal of gastroenterology & hepatology, 2018</p><p class="ds-related-work--abstract ds2-5-body-sm">Guidelines advocate minimally invasive drainage rather than open surgery for infected pancreatic necrosis (IPN) after acute pancreatitis. We hypothesized that the conservative approach could be extended even further by treating patients using an antibiotics-only protocol. Between June 2009 and July 2017, patients with IPN were selectively managed with carbapenem antibiotics for a minimum of 6 weeks. We compared these patients with patients who underwent minimal access retroperitoneal pancreatic necrosectomy (MARPN) for IPN to identify characteristics of this patient group. Of 33 patients with radiologically proven IPN, 13 patients received antibiotics without any surgical or radiological intervention and resulted in no disease-specific mortality and one case of pancreatic insufficiency. In comparison, 44 patients underwent MARPN with a mortality of 20%, and 81.8% developed pancreatic insufficiency. The modified Glasgow score and computed tomography severity score was less in the ant...</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Can infected pancreatic necrosis really be managed conservatively?","attachmentId":111939875,"attachmentType":"pdf","work_url":"https://www.academia.edu/115571335/Can_infected_pancreatic_necrosis_really_be_managed_conservatively","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/115571335/Can_infected_pancreatic_necrosis_really_be_managed_conservatively"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="2" data-entity-id="58480090" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/58480090/Management_of_infected_pancreatic_necrosis_state_of_the_art">Management of infected pancreatic necrosis: state of the art</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="40845374" href="https://usp-br.academia.edu/FernandoDaCostaFerreiraNovo">Fernando Da Costa Ferreira Novo</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Revista do Colégio Brasileiro de Cirurgiões</p><p class="ds-related-work--abstract ds2-5-body-sm">Pancreatic necrosis occurs in 15% of acute pancreatitis. The presence of infection is the most important factor in the evolution of pancreatitis. The diagnosis of infection is still challenging. Mortality in infected necrosis is 20%; in the presence of organic dysfunction, mortality reaches 60%. In the last three decades, there has been a real revolution in the treatment of infected pancreatic necrosis. However, the challenges persist and there are many unsolved questions: antibiotic treatment alone, tomography-guided percutaneous drainage, endoscopic drainage, video-assisted extraperitoneal debridement, extraperitoneal access, open necrosectomy? A step up approach has been proposed, beginning with less invasive procedures and reserving the operative intervention for patients in which the previous procedure did not solve the problem definitively. Indication and timing of the intervention should be determined by the clinical course. Ideally, the intervention should be done only after...</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Management of infected pancreatic necrosis: state of the art","attachmentId":72870393,"attachmentType":"pdf","work_url":"https://www.academia.edu/58480090/Management_of_infected_pancreatic_necrosis_state_of_the_art","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/58480090/Management_of_infected_pancreatic_necrosis_state_of_the_art"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="3" data-entity-id="124523452" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/124523452/Minimally_Invasive_Necrosectomy_Versus_Conventional_Surgery_in_the_Treatment_of_Infected_Pancreatic_Necrosis">Minimally Invasive Necrosectomy Versus Conventional Surgery in the Treatment of Infected Pancreatic Necrosis</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="323361325" href="https://independent.academia.edu/carloboselli2">carlo boselli</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Surgical Laparoscopy, Endoscopy &amp; Percutaneous Techniques, 2013</p><p class="ds-related-work--abstract ds2-5-body-sm">The purpose of this meta-analysis and systematic review is to compare minimally invasive necrosectomy (MIN) versus open necrosectomy (ON) surgery for infected necrosis of acute pancreatitis. Methods: One randomized controlled trial and 3 clinical controlled trials were selected, with a total of 336 patients (215 patients who underwent MIN and 121 patients underwent ON) included after searching in the following databases:</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Minimally Invasive Necrosectomy Versus Conventional Surgery in the Treatment of Infected Pancreatic Necrosis","attachmentId":118732035,"attachmentType":"pdf","work_url":"https://www.academia.edu/124523452/Minimally_Invasive_Necrosectomy_Versus_Conventional_Surgery_in_the_Treatment_of_Infected_Pancreatic_Necrosis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/124523452/Minimally_Invasive_Necrosectomy_Versus_Conventional_Surgery_in_the_Treatment_of_Infected_Pancreatic_Necrosis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="4" data-entity-id="118786617" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/118786617/Open_Pancreatic_Necrosectomy_Is_Still_Safe_and_Effective_Treatment_for_Pancreatic_Necrosis_Managed_by_Step_Up_Approach">Open Pancreatic Necrosectomy Is Still Safe and Effective Treatment for Pancreatic Necrosis Managed by Step-Up Approach</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="180886399" href="https://independent.academia.edu/BarunMahat">Barun Mahat</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Indian Journal of Surgery, 2020</p><p class="ds-related-work--abstract ds2-5-body-sm">Necrotizing pancreatitis is the most dreadful evolution of acute pancreatitis. Intervention is generally required for infected pancreatic necrosis. Traditionally, the most widely used approach has been open pancreatic necrosectomy (OPN), but it is burdened by high morbidity and mortality. Recently, there has been a paradigm shift in the management (step-up approach) evolving towards minimal invasive techniques depending upon availability of resources and expertise. However, OPN still remains the technique of choice in selected cases and in centers where multidisciplinary team is not available. The aim of the study was to analyze the treatment outcome of pancreatic necrosis by step-up approach and OPN. Retrospective analysis of all patients with pancreatic necrosis requiring intervention during 2015-2019 was done. Patient's demographics, etiology, CT severity scoring, organ failure, and operative complications were analyzed. A total of fifteen patients (out of 80 necrotizing pancreatitis) with suspected or proven infected walled-off necrosis were enrolled. Twelve (80%) were male with mean age of 43.2 years. The most common etiology was alcohol. The mean APACHE II and modified CTSI score was 10.6 and 8.5 respectively. Three (20%) patients had isolated, and eight (53.3%) had multiple organ failure. Two (13.3%) patients were exclusively managed with percutaneous catheter drainage. OPN was performed in the remaining thirteen (86.6%) patients. The overall morbidity and mortality was seen in 46.6% and 26.6% patients respectively. In resource-limited setting, OPN is still safe and a feasible option with acceptable morbidity and mortality. Keywords Necrosectomy . Organ failure . Pancreatitis . Step-up approach The study was approved by the Institute Review Committee.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Open Pancreatic Necrosectomy Is Still Safe and Effective Treatment for Pancreatic Necrosis Managed by Step-Up Approach","attachmentId":114330141,"attachmentType":"pdf","work_url":"https://www.academia.edu/118786617/Open_Pancreatic_Necrosectomy_Is_Still_Safe_and_Effective_Treatment_for_Pancreatic_Necrosis_Managed_by_Step_Up_Approach","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/118786617/Open_Pancreatic_Necrosectomy_Is_Still_Safe_and_Effective_Treatment_for_Pancreatic_Necrosis_Managed_by_Step_Up_Approach"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="5" data-entity-id="124357108" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/124357108/Surgical_approaches_for_treatment_of_infected_acute_necrotizing_pancreatitis">Surgical approaches for treatment of infected acute necrotizing pancreatitis</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="57558041" href="https://independent.academia.edu/TurgutTufan">Turgut Tufan</a></div><p class="ds-related-work--abstract ds2-5-body-sm">Necrotizing Acute Pancreatitis (NAP) complicated by infection is a very serious disease resulting in multi-organ failure. It is still associated with a very high mortality. The aim of our study was to evaluate of Infected Necrotizing Acute Pancreatitis (INAP) in patients treated with the various surgical approaches. We retrospectively reviewed twentythree patients with INAP, who were surgically treated, in order to assess the results of the surgical treatment between 1995 and 2005. Of the cases mentioned, 15 were male while the rest (8 cases) being female (average 52 years of age, range 44-78). The average APACHE II score for whole study group (after 48 h) was 12.8. Operative procedures consisted of external drainage (ED) in 11 cases (48%) and necrosectomy with continuous local lavage (NCL) in 12 cases (52%). The overall mortality rate was 21 percent (n=5). In the group with fatal outcome, first operation performed was ED in three cases and NCL in two cases. The reason for death was multi-organ failure in all patients. During a median follow-up of 20.4 months, 9 (39%) out of 23 patients had one or more late complications: pseudocyst in 5 (21%), pancreatic fistula in 2 (9%), delayed collection in 1 (4%) and incisional hernia in 1 (4%). In patients with infected necrosis who deteriorate during conservative treatment, NCL may be an option with acceptable morbidity, re-operation and mortality rates. We believe that complications during surgical therapy of acute infected necrotizing pancreatitis are carrying high risk factors, but their treatment is not hopeless.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Surgical approaches for treatment of infected acute necrotizing pancreatitis","attachmentId":118598252,"attachmentType":"pdf","work_url":"https://www.academia.edu/124357108/Surgical_approaches_for_treatment_of_infected_acute_necrotizing_pancreatitis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/124357108/Surgical_approaches_for_treatment_of_infected_acute_necrotizing_pancreatitis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="6" data-entity-id="98405613" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/98405613/Infected_pancreatic_necrosis_outcomes_and_clinical_predictors_of_mortality_A_post_hoc_analysis_of_the_MANCTRA_1_international_study">Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="62447847" href="https://ucc-ar.academia.edu/DianaAlejandraPantojaPachajoa">Diana Alejandra Pantoja Pachajoa</a></div><p class="ds-related-work--abstract ds2-5-body-sm">The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intraabdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990).</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study","attachmentId":99765694,"attachmentType":"pdf","work_url":"https://www.academia.edu/98405613/Infected_pancreatic_necrosis_outcomes_and_clinical_predictors_of_mortality_A_post_hoc_analysis_of_the_MANCTRA_1_international_study","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/98405613/Infected_pancreatic_necrosis_outcomes_and_clinical_predictors_of_mortality_A_post_hoc_analysis_of_the_MANCTRA_1_international_study"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="7" data-entity-id="107318182" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/107318182/Progress_in_the_management_of_necrotizing_pancreatitis">Progress in the management of necrotizing pancreatitis</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="36233830" href="https://independent.academia.edu/ShyamVaradarajulu">Shyam Varadarajulu</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Expert Review of Gastroenterology &amp; Hepatology, 2010</p><p class="ds-related-work--abstract ds2-5-body-sm">Pancreatic necrosis, a complication of severe pancreatitis, may become infected, resulting in significant morbidity and potential mortality. Infected necrosis was heretofore considered a surgical condition, and despite aggressive operative management, the mortality remained high. With a better understanding of the natural history of necrosis, established methods to diagnose infection and the increasing use of minimally invasive techniques, less aggressive therapies have been utilized with some success. The present study evaluated a step-up approach for the treatment of infected pancreatic necrosis, utilizing endoscopic and percutaneous techniques, and if ineffective, necrosectomy with a minimally invasive retroperitoneal approach. They compared this step-up approach to the standard open necrosectomy. They demonstrated that when using such an approach compared with open necrosectomy, the frequency of major complications such as organ failure, perforation, fistula or even death was significantly less than in those who received conventional open necrosectomy. Indeed, for those randomized to the step-up approach, roughly a third of the patients were successfully treated with percutaneous drainage alone. In the long-term, development of diabetes was also less frequent in those receiving less aggressive therapy. These findings, in combination with other reports, suggest that the dogma that open necrosectomy is mandatory for all patients with infected necrosis should be re-evaluated, and that less aggressive treatments as part of a multidisciplinary approach can reduce morbidity and mortality.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Progress in the management of necrotizing pancreatitis","attachmentId":106018184,"attachmentType":"pdf","work_url":"https://www.academia.edu/107318182/Progress_in_the_management_of_necrotizing_pancreatitis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/107318182/Progress_in_the_management_of_necrotizing_pancreatitis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="8" data-entity-id="19387633" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/19387633/Infected_pancreatic_necrosis_an_evaluation_of_the_timing_and_technique_of_necrosectomy_in_a_Southeast_Asian_population">Infected pancreatic necrosis--an evaluation of the timing and technique of necrosectomy in a Southeast Asian population</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="39653083" href="https://independent.academia.edu/AlexanderChung2">Alexander Chung</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Annals of the Academy of Medicine, Singapore</p><p class="ds-related-work--abstract ds2-5-body-sm">Acute pancreatitis appears to be less prevalent in multi-ethnic Southeast Asia, where the aetiology also appears to be influenced by ethnicity. As with acute pancreatitis elsewhere, however, pancreatic necrosis is a cause of significant mortality and the aim of this study was to review our institutional experience with pancreatic necrosectomy. The records of all patients who underwent pancreatic necrosectomy from January 2000 to December 2004 were analysed. Indications for surgery were the presence of infected necrosis, unresolving sepsis attributable to ongoing pancreatitis or the presence of gas in the pancreatic bed on imaging. Surgical debridement was achieved by debridement with closure over drains or by debridement with open packing. The cohort comprised 14 of 373 patients admitted for acute pancreatitis (3.8%), with an overall mortality rate of 29%. All patients had infected necrosis with positive bacteriological cultures. Eight patients (57%) underwent debridement with closu...</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Infected pancreatic necrosis--an evaluation of the timing and technique of necrosectomy in a Southeast Asian population","attachmentId":40592088,"attachmentType":"pdf","work_url":"https://www.academia.edu/19387633/Infected_pancreatic_necrosis_an_evaluation_of_the_timing_and_technique_of_necrosectomy_in_a_Southeast_Asian_population","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/19387633/Infected_pancreatic_necrosis_an_evaluation_of_the_timing_and_technique_of_necrosectomy_in_a_Southeast_Asian_population"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-wsj-grid-card" data-collection-position="9" data-entity-id="127681113" data-sort-order="default"><a class="ds-related-work--title js-wsj-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/127681113/Infected_Pancreatic_Necrosis">Infected Pancreatic Necrosis</a><div class="ds-related-work--metadata"><a class="js-wsj-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="1786968" href="https://ucm.academia.edu/AntonioPi">Antonio Pi</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Archives of Surgery, 2002</p><p class="ds-related-work--abstract ds2-5-body-sm">Patients: Fifteen consecutive patients with infected and drained pancreatic necrosis. Interventions: Extraperitoneal translumbar approach to drain and retroperitoneoscopy as a method to propose evolutive control. Main Outcome Measures: Morbidity and mortality. Results: Four (27%) of 15 patients died, and 3 (20%) of 15 patients experienced complications during hospital admission. The retroperitoneal access to infected pancreatic necrosis has low rates of mortality and morbidity and a low percentage of repeated surgeries, and retroperitoneoscopy facilitates evolutive control of treated infected pancreatic necrosis.</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Infected Pancreatic Necrosis","attachmentId":121378505,"attachmentType":"pdf","work_url":"https://www.academia.edu/127681113/Infected_Pancreatic_Necrosis","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-wsj-grid-card-view-pdf" href="https://www.academia.edu/127681113/Infected_Pancreatic_Necrosis"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div></div></div><div class="ds-sticky-ctas--wrapper js-loswp-sticky-ctas hidden"><div class="ds-sticky-ctas--grid-container"><div class="ds-sticky-ctas--container"><button class="ds2-5-button js-swp-download-button" data-signup-modal="{"location":"continue-reading-button--sticky-ctas","attachmentId":108816401,"attachmentType":"pdf","workUrl":null}">See full PDF</button><button class="ds2-5-button ds2-5-button--secondary js-swp-download-button" data-signup-modal="{"location":"download-pdf-button--sticky-ctas","attachmentId":108816401,"attachmentType":"pdf","workUrl":null}"><span class="material-symbols-outlined" style="font-size: 20px" translate="no">download</span>Download PDF</button></div></div></div><div class="ds-below-fold--grid-container"><div class="ds-work--container js-loswp-embedded-document"><div class="attachment_preview" data-attachment="Attachment_108816401" style="display: none"><div class="js-scribd-document-container"><div class="scribd--document-loading js-scribd-document-loader" style="display: block;"><img alt="Loading..." src="//a.academia-assets.com/images/loaders/paper-load.gif" /><p>Loading Preview</p></div></div><div style="text-align: center;"><div class="scribd--no-preview-alert js-preview-unavailable"><p>Sorry, preview is currently unavailable. You can download the paper by clicking the button above.</p></div></div></div></div><div class="ds-sidebar--container js-work-sidebar"><div class="ds-related-content--container"><h2 class="ds-related-content--heading">Related papers</h2><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="0" data-entity-id="47995588" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/47995588/Diagnosis_and_Management_of_Pancreatic_Necrosis_Infection">Diagnosis and Management of Pancreatic Necrosis Infection</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="107889345" href="https://independent.academia.edu/waadfarhat">waad farhat</a></div><p class="ds-related-work--metadata ds2-5-body-xs">Acta Scientific Gastrointestinal Disorders</p><div class="ds-related-work--ctas"><button 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data-collection-position="2" data-entity-id="62006974" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/62006974/Management_of_necrotizing_pancreatitis_and_its_outcome_in_a_secondary_healthcare_institution">Management of necrotizing pancreatitis and its outcome in a secondary healthcare institution</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="142846392" href="https://independent.academia.edu/TanweerKarim">Tanweer Karim</a></div><p class="ds-related-work--metadata ds2-5-body-xs">International Surgery Journal</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Management of necrotizing pancreatitis and its outcome in a secondary healthcare 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href="https://www.academia.edu/117768374/Management_of_Infected_and_Sterile_Pancreatic_Necrosis_by_Programmed_Endoscopic_Necrosectomy"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="9" data-entity-id="64553047" data-sort-order="default"><a class="ds-related-work--title js-related-work-grid-card-title ds2-5-body-md ds2-5-body-link" href="https://www.academia.edu/64553047/Pancreatic_Necrosectomy_When_and_How">Pancreatic Necrosectomy: When and How?</a><div class="ds-related-work--metadata"><a class="js-related-work-grid-card-author ds2-5-body-sm ds2-5-body-link" data-author-id="14570107" href="https://dypatil-in.academia.edu/DrKetanVagholkar">Dr Ketan Vagholkar</a></div><p class="ds-related-work--metadata ds2-5-body-xs">2013</p><div class="ds-related-work--ctas"><button class="ds2-5-text-link ds2-5-text-link--inline js-swp-download-button" data-signup-modal="{"location":"wsj-grid-card-download-pdf-modal","work_title":"Pancreatic Necrosectomy: When and How?","attachmentId":76536877,"attachmentType":"pdf","work_url":"https://www.academia.edu/64553047/Pancreatic_Necrosectomy_When_and_How","alternativeTracking":true}"><span class="material-symbols-outlined" style="font-size: 18px" translate="no">download</span><span class="ds2-5-text-link__content">Download free PDF</span></button><a class="ds2-5-text-link ds2-5-text-link--inline js-related-work-grid-card-view-pdf" href="https://www.academia.edu/64553047/Pancreatic_Necrosectomy_When_and_How"><span class="ds2-5-text-link__content">View PDF</span><span class="material-symbols-outlined" style="font-size: 18px" translate="no">chevron_right</span></a></div></div><div class="ds-related-work--container js-related-work-sidebar-card" data-collection-position="10" data-entity-id="85204574" 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