B. P. T. Loveday MBChB; J. I. Rossaak PhD FRACS; A. Mittal MBChB; A. Phillips MBChB PhD; J. A. Windsor MD, FRACS.
Survey of trends in minimally invasive intervention for necrotizing pancreatitis
Article first published online: 19 MAR 2010
© 2010 The Authors. ANZ Journal of Surgery © 2010 Royal Australasian College of Surgeons
ANZ Journal of Surgery
Volume 81, Issue 1-2, pages 56–64, January/February 2011
How to Cite
Loveday, B. P. T., Rossaak, J. I., Mittal, A., Phillips, A. and Windsor, J. A. (2011), Survey of trends in minimally invasive intervention for necrotizing pancreatitis. ANZ Journal of Surgery, 81: 56–64. doi: 10.1111/j.1445-2197.2010.05265.x
- Issue published online: 19 MAR 2010
- Article first published online: 19 MAR 2010
- Accepted for publication 21 August 2008.
- acute necrotizing pancreatitis;
- interventional radiography;
- minimally invasive surgical procedures;
Background: Minimally invasive techniques to manage infected pancreatic necrosis have been recently developed and changes in their pattern of use are unknown. The aims of this survey were to determine the trends in the role of minimally invasive techniques to manage infected complications of necrotizing pancreatitis and the barriers to performing minimally invasive necrosectomy in Australia and New Zealand.
Methods: Members of the Australian and New Zealand Hepatic Pancreatic and Biliary Association were surveyed. Participant demographics and necrotizing pancreatitis caseload were determined. The perceived role of percutaneous catheter drainage and minimally invasive necrosectomy for pancreatic abscess, infected pseudocyst and infected pancreatic necrosis were scored on Likert scales, comparing 2002 with 2007. Barriers to performing minimally invasive necrosectomy were scored.
Results: The response rate was 49% (44/90). Between 2002 and 2007, the role of percutaneous catheter drainage became more important as primary (P= 0.05) and secondary (P= 0.01) treatment for pancreatic abscess, and prior to minimally invasive necrosectomy for abscess, pseudocyst and necrosis (P < 0.01). Minimally invasive necrosectomy became increasingly important as primary treatment for infected necrosis (P < 0.01) and had been used by 47% of respondents. The greatest barriers to performing minimally invasive necrosectomy were lack of training and experience in the techniques, and the anatomical position and complexity of the target lesion.
Conclusion: Minimally invasive techniques have an increasingly important perceived role in the management of pancreatic abscess, infected pseudocyst and infected pancreatic necrosis. Further evidence is required to determine the best techniques for treating each form of infection associated with necrotizing pancreatitis.