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      Pancreatic necrosis: Complications and changing trend of treatment

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          Abstract

          Incidence of acute pancreatitis seems to be increasing in the Western countries and has been associated with significantly increased morbidity. Nearly 80% of the patients with acute pancreatitis undergo resolution; some develop complications including pancreatic necrosis. Infection of pancreatic necrosis is the leading cause of death in these patients. A significant portion of these patients needs surgical interventions. Traditionally, the “gold standard” procedure has been the open surgical necrosectomy, which is now being completed by the relatively lesser invasive interventions. Minimally invasive surgical (MIS) procedures include endoscopic drainage, percutaneous image-guided catheter drainage, and retroperitoneal drainage. This review article discusses the open and MIS interventions for pancreatic necrosis with each having its own respective benefits and disadvantages are covered.

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          Most cited references135

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          Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. II. Recommendations.

          Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been increasingly recognized in the critically ill over the past decade. In the absence of consensus definitions and treatment guidelines the diagnosis and management of IAH and ACS remains variable from institution to institution. An international consensus group of multidisciplinary critical care specialists convened at the second World Congress on Abdominal Compartment Syndrome to develop practice guidelines for the diagnosis, management, and prevention of IAH and ACS. Prior to the conference the authors developed a blueprint for consensus definitions and treatment guidelines which were refined both during and after the conference. The present article is the second installment of the final report from the 2004 International ACS Consensus Definitions Conference and is endorsed by the World Society of the Abdominal Compartment Syndrome. The prevalence and etiological factors for IAH and ACS are reviewed. Evidence-based medicine treatment guidelines are presented to facilitate the diagnosis and management of IAH and ACS. Recommendations to guide future studies are proposed. These definitions, guidelines, and recommendations, based upon current best evidence and expert opinion are proposed to assist clinicians in the management of IAH and ACS as well as serve as a reference for future clinical and basic science research.
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            Acute pancreatitis.

            Acute pancreatitis is an inflammatory disease of the pancreas. Acute abdominal pain is the most common symptom, and increased concentrations of serum amylase and lipase confirm the diagnosis. Pancreatic injury is mild in 80% of patients, who recover without complications. The remaining patients have a severe disease with local and systemic complications. Gallstone migration into the common bile duct and alcohol abuse are the most frequent causes of pancreatitis in adults. About 15-25% of pancreatitis episodes are of unknown origin. Treatment of mild disease is supportive, but severe episodes need management by a multidisciplinary team including gastroenterologists, interventional radiologists, intensivists, and surgeons. Improved understanding of pathophysiology and better assessments of disease severity should ameliorate the management and outcome of this complex disease.
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              Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis.

              All patients with organ dysfunction are currently classified as having severe acute pancreatitis. The aim of this study was to characterize the systemic inflammatory response syndrome (SIRS) and early organ dysfunction in patients with acute pancreatitis and the relationship with overall mortality. Patients with predicted severe acute pancreatitis of less than 48 h duration had daily organ dysfunction scores and SIRS criteria calculated. These features were then correlated with outcome. Of 121 patients, 68 (56 per cent) did not develop organ dysfunction; only two of these patients died (mortality rate 3 per cent). Fifty-three (44 per cent) had early organ dysfunction, of whom 11 died (21 per cent). Organ dysfunction and persistent SIRS were both associated with an increased mortality rate, but on multivariate analysis only deteriorating organ dysfunction was an independent determinant of survival. Early organ dysfunction in acute pancreatitis usually resolves and in itself has no significant influence on mortality. In contrast, worsening organ dysfunction was associated with death in more than half of the patients (11 of 20); it is this group of patients who should be classified as having severe acute pancreatitis.
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                Author and article information

                Contributors
                Journal
                World J Gastrointest Surg
                WJGS
                World Journal of Gastrointestinal Surgery
                Baishideng Publishing Group Inc
                1948-9366
                27 April 2019
                27 April 2019
                : 11
                : 4
                : 198-217
                Affiliations
                Department of Internal Medicine, Advent Health Graduate Medical Education, Orlando, FL 32804, United States. mamoon.rashid.md@ 123456adventhealth.com
                Department of Gastroenterology, Cleveland Clinic, Weston, FL 33326, United States
                Department of Gastroenterology, Cleveland Clinic, Weston, FL 33326, United States
                Internal Medicine, Abington Hospital, Abington, PA 19001, United States
                Department of Internal Medicine, Advent Health Graduate Medical Education, Orlando, FL 32804, United States
                Department of Internal Medicine, Advent Health Graduate Medical Education, Orlando, FL 32804, United States
                Department of Internal Medicine, Advent Health Graduate Medical Education, Orlando, FL 32804, United States
                Department of Gynecologic Oncology, Advent Health Cancer Institute, Orlando, FL 32804, United States
                Author notes

                Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.

                Corresponding author: Mamoon Ur Rashid, MBBS, MD, Doctor, Medical Resident, Department of Internal Medicine, Advent Health Graduate Medical Education, 2501 North Orange Avenue, Orlando, FL 32804, United States. mamoon.rashid.md@ 123456adventhealth.com

                Telephone: +1-407-3122766 Fax: +1-407-3032435

                Article
                jWJGS.v11.i4.pg198
                10.4240/wjgs.v11.i4.198
                6513789
                31123558
                94904e8a-b3ae-412b-aee7-0e261981c028
                ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.

                This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

                History
                : 12 March 2019
                : 19 April 2019
                : 23 April 2019
                Categories
                Review

                pancreatic necrosis,necrosectomy,open surgery,minimally invasive surgery,complications,treatment,review article

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