Minimally Invasive Surgery Compared to Endoscopic Intervention for Treating Infected Pancreatic Necrosis. A Meta-analysis

Overview

Journal Wideochir Inne Tech Maloinwazyjne

Publisher Termedia

Date 2024 Jul 8

PMID 38973796

Authors

Guangjiang Wu

Can Cui

Qingkun Song

Affiliations

Soon will be listed here.

Abstract

Introduction: The current study aimed to compare the outcomes of endoscopic and minimally invasive surgical treatment for infected necrotizing pancreatitis.

Material And Methods: A meta-analysis of clinical studies on minimally invasive operations for necrotic infection was conducted. A systematic review and study inclusion were done on multiple databases. English-language prospective comparison studies were included. Random design was used to analyze research with continuous and dichotomous variables.

Results: Ten studies were included in the current study. When compared to minimally invasive surgery, endoscopic procedures showed significant beneficial outcomes regarding low post-operative complication rates (p = 0.006), new onset organ failure (p < 0.001), and pancreatic fistula (p < 0.001). However, there was no significant difference between the two interventions regarding hospital stay, postoperative bleeding, incisional hernia, endocrine insufficiency, and perforation of a visceral organ.

Conclusions: Endoscopic therapy appears to have potential advantages over minimally invasive surgery. However, there is no difference between interventions regarding several parameters.

References

Abdelhafez M, Elnegouly M, Hasab Allah M, Elshazli M, Mikhail H, Yosry A . Transluminal retroperitoneal endoscopic necrosectomy with the use of hydrogen peroxide and without external irrigation: a novel approach for the treatment of walled-off pancreatic necrosis. Surg Endosc. 2013; 27(10):3911-20. DOI: 10.1007/s00464-013-2948-x. View

Bang J, Arnoletti J, Holt B, Sutton B, Hasan M, Navaneethan U . An Endoscopic Transluminal Approach, Compared With Minimally Invasive Surgery, Reduces Complications and Costs for Patients With Necrotizing Pancreatitis. Gastroenterology. 2018; 156(4):1027-1040.e3. DOI: 10.1053/j.gastro.2018.11.031. View

Mohiuddin K, Swanson S . Maximizing the benefit of minimally invasive surgery. J Surg Oncol. 2013; 108(5):315-9. DOI: 10.1002/jso.23398. View

Rogalski P, Daniluk J, Baniukiewicz A, Wroblewski E, Dabrowski A . Endoscopic management of gastrointestinal perforations, leaks and fistulas. World J Gastroenterol. 2015; 21(37):10542-52. PMC: 4588076. DOI: 10.3748/wjg.v21.i37.10542. View

Bausch D, Wellner U, Kahl S, Kuesters S, Richter-Schrag H, Utzolino S . Minimally invasive operations for acute necrotizing pancreatitis: comparison of minimally invasive retroperitoneal necrosectomy with endoscopic transgastric necrosectomy. Surgery. 2012; 152(3 Suppl 1):S128-34. DOI: 10.1016/j.surg.2012.05.021. View

Garg P, Meena D, Babu D, Padhan R, Dhingra R, Krishna A . Endoscopic versus laparoscopic drainage of pseudocyst and walled-off necrosis following acute pancreatitis: a randomized trial. Surg Endosc. 2019; 34(3):1157-1166. DOI: 10.1007/s00464-019-06866-z. View

Alkaaki A, Al-Radi O, Khoja A, Alnawawi A, Alnawawi A, Maghrabi A . Surgical site infection following abdominal surgery: a prospective cohort study. Can J Surg. 2019; 62(2):111-117. PMC: 6440888. DOI: 10.1503/cjs.004818. View

Szeliga J, Jackowski M . Minimally invasive procedures in severe acute pancreatitis treatment - assessment of benefits and possibilities of use. Wideochir Inne Tech Maloinwazyjne. 2014; 9(2):170-8. PMC: 4105673. DOI: 10.5114/wiitm.2014.41628. View

Malmstrom M, Hansen M, Moller Andersen A, Ersboll A, Nielsen O, Jorgensen L . Cytokines and organ failure in acute pancreatitis: inflammatory response in acute pancreatitis. Pancreas. 2011; 41(2):271-7. DOI: 10.1097/MPA.0b013e3182240552. View

10.

Papachristou G, Takahashi N, Chahal P, Sarr M, Baron T . Peroral endoscopic drainage/debridement of walled-off pancreatic necrosis. Ann Surg. 2007; 245(6):943-51. PMC: 1876949. DOI: 10.1097/01.sla.0000254366.19366.69. View

11.

Haghshenasskashani A, Laurence J, Kwan V, Johnston E, Hollands M, Richardson A . Endoscopic necrosectomy of pancreatic necrosis: a systematic review. Surg Endosc. 2011; 25(12):3724-30. DOI: 10.1007/s00464-011-1795-x. View

12.

Kumar N, Conwell D, Thompson C . Direct endoscopic necrosectomy versus step-up approach for walled-off pancreatic necrosis: comparison of clinical outcome and health care utilization. Pancreas. 2014; 43(8):1334-9. PMC: 5019103. DOI: 10.1097/MPA.0000000000000213. View

13.

Escourrou J, Shehab H, Buscail L, Bournet B, Andrau P, Moreau J . Peroral transgastric/transduodenal necrosectomy: success in the treatment of infected pancreatic necrosis. Ann Surg. 2008; 248(6):1074-80. DOI: 10.1097/SLA.0b013e31818b728b. View

14.

Boxhoorn L, Fockens P, Besselink M, Bruno M, van Hooft J, Verdonk R . Endoscopic Management of Infected Necrotizing Pancreatitis: an Evidence-Based Approach. Curr Treat Options Gastroenterol. 2018; 16(3):333-344. PMC: 6153579. DOI: 10.1007/s11938-018-0189-8. View

15.

Wronski M, Cebulski W, Slodkowski M, Krasnodebski I . Minimally invasive treatment of infected pancreatic necrosis. Prz Gastroenterol. 2015; 9(6):317-24. PMC: 4300346. DOI: 10.5114/pg.2014.47893. View

16.

Onnekink A, Boxhoorn L, Timmerhuis H, Bac S, Besselink M, Boermeester M . Endoscopic Versus Surgical Step-Up Approach for Infected Necrotizing Pancreatitis (ExTENSION): Long-term Follow-up of a Randomized Trial. Gastroenterology. 2022; 163(3):712-722.e14. DOI: 10.1053/j.gastro.2022.05.015. View

17.

Bakker O, van Santvoort H, van Brunschot S, Geskus R, Besselink M, Bollen T . Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA. 2012; 307(10):1053-61. DOI: 10.1001/jama.2012.276. View

18.

Trikudanathan G, Attam R, Arain M, Mallery S, Freeman M . Endoscopic interventions for necrotizing pancreatitis. Am J Gastroenterol. 2014; 109(7):969-81. DOI: 10.1038/ajg.2014.130. View

19.

Timmermann L, Schonauer S, Hillebrandt K, Felsenstein M, Pratschke J, Malinka T . Endoscopic and surgical treatment of necrotizing pancreatitis-a comparison of short- and long-term outcome. Langenbecks Arch Surg. 2024; 409(1):58. PMC: 10861384. DOI: 10.1007/s00423-024-03244-9. View

20.

Zerem E . Treatment of severe acute pancreatitis and its complications. World J Gastroenterol. 2014; 20(38):13879-92. PMC: 4194569. DOI: 10.3748/wjg.v20.i38.13879. View