Published: 2017-01-16

A study of the role of intervention in the final outcome of acute pancreatitis

Vengadakrishnan Krishnamoorthy, Koushik A. K.


Background: Acute pancreatitis is a common disease which varies in severity, from mild self-limiting pancreatic inflammation to severe pancreatic necrosis with life-threatening sequelae. As per the recent recommendations early intensive care with delayed intervention and step-up approach when indicated has definite survival advantages over the risks associated with early surgical procedures. The present study was aimed at evaluating the mortality and morbidity risk in patients undergoing procedural intervention in acute pancreatitis.

Methods: This was a prospective study done in Sri Ramachandra Medical College and Hospital from April 2012- September 2014. All patients with a diagnosis of acute pancreatitis were included in this study. A total of 110 patients were analysed. Routine lab parameters, serum amylase, lipase, lipid profile, calcium, CRP, LDH, CT abdomen, CXR and 2D Echo was done for all patients. Procedural intervention was planned as per the guidelines.

Results: Patients were given early intensive care as per the initial severity scores. 25 patients required intervention. Serum LDH, amylase, lipase and CT severity index were better predictors of requirement of intervention and death. Open necrosectomy was done in 15 patients (13.6%), laparoscopic necrosectomy in 3 patients (2.7%) and step up approach was tried in 7 patients (6.4%). Patients who were tried step up approach were monitored closely for any deterioration in their clinical condition to decide about surgery. 7 out of 8 patients who underwent surgery died.  Alcoholic pancreatitis that underwent intervention had a high risk of mortality.

Conclusions: Intensive care monitoring with delayed intervention had a better survival benefit. Patients subjected to minimally invasive interventions had a better chance of survival.



Acute pancreatitis, Pancreatitis necrosis, Step-up surgery, Necrosectomy

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Beger HG, Rau BM. Severe acute pancreatitis: Clinical course and management. World J Gastroenterol. 2007;13:5043.

Swaroop VS, Chari ST, Clain JE. Severe acute pancreatitis. JAMA. 2004;291:2865.

Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013; 62:102.

Marshall JC. Cook DJ. Christou NV. Bernard GR, et al. multiple organ dysfunction score: a reliable descriptor of a complex clinical outcome. Crit Care Med. 1995;23:1638-52.

Gloor B, Muller CA, Worni M, Martignoni ME, et al. Late mortality in patients with severe acute pancreatitis. Br J Surg. 2001;88:975-9.

Eatock FC, Chong P, Menezes N, et al. A randomized study of early nasogastric versus nasojejunal feeding in severe acute pancreatitis. Am J Gastroenterol. 2005;100:432.

Hartwig W, Maksan SM, Foitzik T, et al. Reduction in mortality with delayed surgical therapy of severe pancreatitis. J Gastrointest Surg 2002;6:481.

Uhl W, Warshaw A, Imrie C, et al. IAP Guidelines for the Surgical Management of Acute Pancreatitis. Pancreatology 2002;2:565.

Robert JH, Frossard JL, Mermillod B, et al. Early prediction of acute pancreatitis: prospective study comparing computed tomography scans, Ranson, Glasgow, Acute Physiology and Chronic Health Evaluation II scores, and various serum markers. World J Surg 2002;26:612.

Yadav D, Agarwal N, Pitchumoni CS. A critical evaluation of laboratory tests in acute pancreatitis. Am J Gastroenterol. 2002;97:1309.

Freeman ML, Werner J, van Santvoort HC, et al. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas 2012;41:1176.

Wysocki AP, McKay CJ, Carter CR. Infected pancreatic necrosis: minimizing the cut. ANZ J Surg. 2010;80:58.

Navaneethan U, Vege SS, Chari ST, Baron TH. Minimally invasive techniques in pancreatic necrosis. Pancreas. 2009;38:867.

Besselink MG, van Santvoort HC, Nieuwenhuijs VB, et al. Minimally invasive 'step-up approach' versus maximal necrosectomy in patients with acute necrotising pancreatitis (PANTER trial): design and rationale of a randomised controlled multicenter trial [ISRCTN13975868]. BMC Surg. 2006;6:6.

Mortelé KJ, Girshman J, Szejnfeld D, et al. CT-guided percutaneous catheter drainage of acute necrotizing pancreatitis: clinical experience and observations in patients with sterile and infected necrosis. AJR Am J Roentgenol 2009;192:110. 144:1272.

Van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010;362:1491.

Howard TJ, Patel JB, Zyromski N, et al. Declining morbidity and mortality rates in the surgical management of pancreatic necrosis. J Gastrointest Surg. 2007;11:43.

Papachristou GI, Takahashi N, Chahal P, et al. Peroral endoscopic drainage/debridement of walled-off pancreatic necrosis. Ann Surg. 2007;245:943.

Parekh D. Laparoscopic-assisted pancreatic necrosectomy: A new surgical option for treatment of severe necrotizing pancreatitis. Arch Surg. 2006;141:895.

Harrison S, Kakade M, Varadarajula S, et al. Characteristics and outcomes of patients undergoing debridement of pancreatic necrosis. J Gastrointest Surg. 2010;14:245.