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Table 2 Data on operative management and post-operative course

From: Open necrosectomy is feasible as a last resort in selected cases with infected pancreatic necrosis: a case series and systematic literature review

Study Indications to surgery technical note IPN (%) Collection Time until necrosectomy from admission in days Pathogens (most frequently found %) Mortality (%) Re-necrosectomies New onset organ failure OF
(%)
PF (%) POB (%) NB (%) PEI (%) Follow-up month
Husu et al. [26] *Infected pancreatic necrosis
*Organ failure
*Prolonged pain *Bleeding
*Gastric outlet obstruction
Upper transvers subcostal laparotomy 85/109 (77.9) Not assessable 45 (41.3%) < 30% 31 (28.4%) 30–50% 11 (10.1%) > 50% 22 (20.2%) 36 (22–59) Nr 25 (22.9) 27 (24.7) Nr 43 39.4 11
10.1
Nr Nr Nr
Martinez et al. [27] *Infected pancreatic necrosis
*Necrotic pancreatitis
*Organ failure
Longitudinal midline trans-peritoneal approach 26/34 (76.4) Nr 10.5 (4–23) -Yeast 10 (29.4)
-Strept. Angin. 9 (26.5)
-E. Coli 7 (20.6)
7
(20.6)
11/34
(32.4)
Nr Nr Nr Nr Nr Nr
Cao et al. [28] *Infected pancreatic necrosis
*Organ failure
*Trans-lesser sac approach 32 *Eetroperitoneal approach 11 *Combined 2 45 (100) Ho 16
He 33
51.84 ± 28.48 Nr 4
(8.8)
Nr Nr 10
22.2
2
4.4
3
6.7
1
2.2
18
Šileikis et al [29] *Infected pancreatic necrosis FNA
*Suspected Infected pancreatic necrosis/Organ failure/sepsis
Nr 42 (79.3) Nr 28.8 ± 14.0 Nr 34 (64.1) Nr Nr 38
71.7
Nr Nr Nr
Wroński et al [30] *Confirmed or suspected Infected pancreatic necrosis FNA 17
*Persisting unwellness 5
Transperitoneal necrosectomy
-midline
-subcostal
17 (77.3) < 30% 5 (22.7%) 30–50% 4 (18.2%) > 50% 9 (40.9%) 40.5 (27–71) Nr 6 (27.3)   12 (54.5) 7 31.8 6 28.6 Nr Nr Nr
Rash et al [31] *Infected pancreatic necrosis FNA
*Suspected Infected pancreatic necrosis/Organ failure/sepsis
  25/30 (83.3) Nr > 10 days after onset of symptom Nr 10 (33.3) Median number of interventions 4 (r. 0–78) Nr Nr Nr 10
33.3
Nr Nr
Gomatos et al [32] *Infected pancreatic necrosis
*Organ failure/sepsis
*Persisting unwellness
transperitoneal necrosectomy 78 (65) Not assessable 20 (16.7%) < 30% 27 (22.5%) 30–50% 34 (28.3%) > 50% 39 (32.5%) 24 (12.8–42.3) Nr 28 (23.3)   42 (35.0) 14 11.7 18 15.0 Nr Nr Nr
Barreda et al. [33] *Infected pancreatic necrosis 31
*Organ failure 5
/ 28/36 (77.7) Nr 38.5 (13–90) E. coli 13 (46) 6 (16.6) Nr nr nr nr Nr Nr Nr
Pupelis G et al [34] *Infected pancreatic necrosis
*Organ failure
Longitudinal midline or bilateral subcostal trans-peritoneal approach 32 (82) > 50% 22 (56.4%) 22 (17–27) E. coli Enterococcus 5 (12.8) Nr   5 12.8 9 23.1 Nr Nr Nr
Tan V et al [35] *Infected pancreatic necrosis 21 Bi-subcostal trans-peritoneal approach (cholecystectomy associated) post-operative irrigation 19 (90) Nr 21 (3–120) Nr 3 (14) Nr 5 (17) 8 38.0 3 14.0 4
19.0
4 19.0 16.1
Madenci et al [36] *Infected pancreatic necrosis 43
*Failure to thrive 13 (19.1)
*Sepsis syndrome 9 (13.2)
*Biliary obstruction 2 (2.9)
*Hemorrhage 1 (1.5)
Transmesocolic 47 (70.1%)
Anterior 20 (30.3%)
Retroperitoneal 3 (4.5%)
*Preop detected 43 (63)
*Newly detected 11 (16.2)
Not assessable 7 (14.9%) < 30% 15 (31.9%) 30–50% 5 (10.6%) > 50% 20 (40.5%) 39.5 (29–73) Polymicrobial 19 (28) 6 (8.8) 10 (14.7) 17 (25.0) 49 74.2 12 17.7 14 20.6 7 10.3 23
Pascual et al [37] *Infected pancreatic necrosis 21 Open debridement, necrosectomy and drainage lavage 21/21 (100) Nr 18.6 ± 16.9 (r = 1–76) Nr 9 (42.9) Nr 10 (47.7) 6 28.6 4 19.0 4/12 2/12 Nr
Tu et al [38] *Infected pancreatic necrosis
*Organ failure
Longitudinal or crosscut incision; trans-lesser sac approach 32/32 (100) Nr 18.3 (6–31) Nr 4 (12.5) Nr Nr 11 2 Nr Nr Nr
Senthil Kumar et al [39] *Infected pancreatic necrosis 15 Transperitoneal necrosectomy 15/15 (100) He 15 31 (17–45) Nr 1 (6.7) 2 3 1 5 Nr Nr Nr
Bausch et al [40] *Infected pancreatic necrosis 1
*Organ failure/sepsis 16
*Other 13
Transperitoneal necrosectomy 25/30 (100) Nr 11 (0–77) nr 19 (63.3) 22 Nr 5 8 Nr Nr Nr
Tan et al [41] *Infected pancreatic necrosis 51 Transperitoneal necrosectomy 67/76 (88.6) Nr 30 (13–46) Pseudomonas. 3 (5.9%) 1 Nr 28 3 Nr Nr Nr
Doctor et al [42] *Infected pancreatic necrosis
*Organ failure/sepsis
*Persisting unwellness
Transperitoneal necrosectomy 51 (83.6) Nr 29 (13–46) E. coli, Klebsiella. Acinetobacter., Pseudomonas 6 (9.8) 2 Nr 31 (50.8) 4 Nr Nr Nr
Boland et al [43] *Infected pancreatic necrosis
*Organ failure/sepsis
Open deb 9 (43%)
Open CG 6 (29%)
Lap deb 4 (19%)
Lap CG 2(9%)
21 (100) Nr 77 (32–155) Enterococcus 8
Candida species 7 E. Coli 5
1 (open deb) Nr Nr Nr 1 (open deb) Nr Nr Nr
Raraty et al [11] *Infected pancreatic necrosis FNA + 15
*Suspected Infected pancreatic necrosis/Organ failure/sepsis 13
transperitoneal necrosectomy
-Midline17
-Transvers11
15 (53.6) > 50% 31 (60%) 34 (5–149) E. coli 6 (21.4) median number of interventions 1 (1–9) Nr 4 Nr Nr Nr Nr
van Santvoort et al [13] *Infected pancreatic necrosis FNA + *suspected Infected pancreatic necrosis/organ failure/sepsis Surgical necrosectomies through bi-subcostal incision 42 (93) < 30% 19 (42%) 30–50% 10 (22%) > 50% 16 (36%) 29 (12–155) Nr 7 (16) 14 19 (42) 17 (38) 10 (22) 17 (38) 15 (33) 6
  1. Ho homogeneous, He heterogeneous, IPN infected pancreatic necrosis, CV cardiovascular disease, P pulmonary disease, CRI chronic renal disease, D diabetes, OT other, PF pancreatic fistula, POB postoperative bleeding, NB new-onset diabetes, PEI pancreatic exocrine insufficiency