Management of infected necrotizing pancreatitis with open abdomen and negative pressure therapy
DOI:
https://doi.org/10.18203/2320-6012.ijrms20252797Keywords:
Infected pancreatic necrosis, Negative pressure therapy, Barker techniqueAbstract
Severe acute pancreatitis (SAP) may progress to infected necrotizing pancreatic (INP) and abdominal compartment syndrome (ACS), significantly increasing mortality and requiring prompt intervention. A step-up approach—including percutaneous drainage, endoscopic procedures, and, in severe cases, open surgery with open abdomen management and negative pressure therapy (NPT)—has demonstrated improved outcomes. This article reviews optimal management of complicated SAP and the role of NPT in reducing morbidity and mortality. A 31 years old female developed infected pancreatic necrosis and abdominal compartment syndrome. Initial management included necrosectomy with closed and open drains, followed by primary fascial closure but the patient continued to deterioration. Therefore, she underwent reoperation with surgical debridement and application of NPT technique. The patient recovered without disabling sequelae. Current IPN management prioritizes radiological or endoscopic interventions. However, open abdomen with NPT remains a viable option when minimally invasive approaches fail or are unavailable. Here the NTP shows favorable outcomes despite limited published evidence.
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Ciuntu BM, Vintilă D, Tanevski A, Chiriac Ș, Stefănescu G, Abdulan IM, et al. Severe Acute Pancreatitis Treated with Negative Pressure Wound Therapy System: Influence of Laboratory Markers. J Clin Med. 2023;12(11):3721. DOI: https://doi.org/10.3390/jcm12113721
García-Corral JR, Cárdenas-Lailson LE, Sanjuan-Martínez CA, Arellano-Solorio CH, Aquino-Matus JE, Carrillo-Romero A. Negative pressure therapy combined with mesh fascial traction in the treatment of infected pancreatic necrosis. A new therapeutic option. Cir Cir. 2019;87(2):219-23. DOI: https://doi.org/10.24875/CIRU.18000472
Husu HL, Leppäniemi AK, Mentula PJ. Who would benefit from open abdomen in severe acute pancreatitis?-a matched case-control study. World J Emerg Surg. 2021;16(1):32. DOI: https://doi.org/10.1186/s13017-021-00376-x
Shi X, Lin L, Sun J. The Value of Continuous Closed Negative Pressure Drainage Combined with Antibacterial Biofilm Dressing in Postoperative Wound Healing for Severe Pancreatitis. Altern Ther Health Med. 2023;29(5):375-9.
Tsogt L, Nachin B, Gunsentsoodol B, Jambaldorj K. Open Vacuum Pressure Treatment of Pancreatic Necrosis. Central Asian J Med Sci. 2021;7(3):285-92. DOI: https://doi.org/10.24079/cajms.2021.09.014
Ciuntu BM, Vasiluta C, Anton N, Ciuntu R, Damian M, Ciumanghel A, et al. Negative pressure therapy in abdominal compartment syndrome. Revista de Chimie. 2017;68(8):1923-7. DOI: https://doi.org/10.37358/RC.17.8.5792
Sermoneta D, Di Mugno M, Spada PL, Lodoli C, Carvelli ME, Magalini SC, et al. Intra-abdominal vacuum-assisted closure (VAC) after necrosectomy for acute necrotising pancreatitis: preliminary experience. Int Wound J. 2010;7(6):525-30. DOI: https://doi.org/10.1111/j.1742-481X.2010.00727.x
Zarnescu NO, Dumitrascu I, Zarnescu EC, Costea R. Abdominal Compartment Syndrome in Acute Pancreatitis: A Narrative Review. Diagnostics (Basel). 2022;13(1):1. DOI: https://doi.org/10.3390/diagnostics13010001
Henn J, Lingohr P, Branchi V, Semaan A, von Websky MW, Glowka TR, et al. Open Abdomen Treatment in Acute Pancreatitis. Front Surg. 2021;7:588228. DOI: https://doi.org/10.3389/fsurg.2020.588228
Ana MD, Ángel ZG, Dolores GRM, Amaia ER, Silvia GH, Joseba CV, et al. Técnica “Vacuum Pack” De Barker. Aplicada Al Cierre Temporal Del Abdomen En Cirugía De Urgencias. 2nd Edition. Elsevier. 2013.
López-Quintero L, Evaristo-Méndez G, Fuentes-Flores F, Ventura-González F, Sepúlveda-Castro R. Tratamiento de abdomen abierto con el sistema de vacuum pack en pacientes con sepsis abdominal. Cir Cir. 2010;78:322-6.
van Brunschot S, Hollemans RA, Bakker OJ, Besselink MG, Baron TH, Beger HG, et al. Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients. Gut. 2018;67(4):697-706.
Oh CH, Lee JK, Song TJ, Park JS, Lee JM, Son JH, et al. Clinical Practice Guidelines for the Endoscopic Management of Peripancreatic Fluid Collections. Clin Endosc. 2021;54(4):505-21. DOI: https://doi.org/10.5946/ce.2021.185
Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13(4):e1-15. DOI: https://doi.org/10.1016/j.pan.2013.07.063
Leppäniemi A, Tolonen M, Tarasconi A, Segovia-Lohse H, Gamberini E, Kirkpatrick AW, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019;14:27. DOI: https://doi.org/10.1186/s13017-019-0247-0
Bradley EL, Dexter ND. Management of severe acute pancreatitis: a surgical odyssey. Ann Surg. 2010;251(1):6-17. DOI: https://doi.org/10.1097/SLA.0b013e3181c72b79
Carlson GL, Patrick H, Amin AI, McPherson G, MacLennan G, Afolabi E, et al. Management of the open abdomen: a national study of clinical outcome and safety of negative pressure wound therapy. Ann Surg. 2013;257(6):1154-9. DOI: https://doi.org/10.1097/SLA.0b013e31828b8bc8
Coccolini F, Biffl W, Catena F, Ceresoli M, Chiara O, Cimbanassi S, et al. The open abdomen, indications, management and definitive closure. World J Emerg Surg. 2015;10:32. DOI: https://doi.org/10.1186/s13017-015-0026-5
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