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Step-up approach combined with negative pressure wound therapy for the treatment of severe necrotizing pancreatitis: a case report

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Abstract

A step-up approach and continuous drainage using NPWT was an effective strategy for the treatment of severe necrotizing pancreatitis. A 62-year-old woman developed severe necrotizing pancreatitis after endoscopic retrograde cholangiopancreatography, extending from the left anterior pararenal space to the interior renal pole. Endoscopic transluminal drainage and percutaneous catheter drainage were unsuccessful in controlling the disease. We proceeded with video-assisted retroperitoneal necrosectomy, at the pancreas and splenic hilum, and drainage, with two additional surgical drains located at the left inferior renal pole and, subcutaneously, at the incision wound. NPWT enhanced fluid drainage and facilitated surgical wound closure, which was infected and opened. Four subsequent endoscopic necrosectomy procedures were required, at the site of the draining fistula, to achieve complete resolution of fluid collection and wound closure.

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References

  1. Horwood J, Akbar F, Maw A. Initial experience of laparostomy with immediate vacuum therapy in patients with severe peritonitis. Ann R Coll Surg Engl. 2009;91:681–7.

    PubMed  PubMed Central  Google Scholar 

  2. Capobianco CM, Zgonis T. An overview of negative pressure wound therapy for the lower extremity. Clin Podiatr Med Surg. 2009;26:619–31.

    PubMed  Google Scholar 

  3. Batacchi S, Matano S, Nella A, et al. Vacuum-assisted closure device enhances recovery of critically ill patients following emergency surgical procedures. Crit Care (London, England). 2009;13:R194.

    Google Scholar 

  4. Cirocchi R, Birindelli A, Biffl WL, et al. What is the effectiveness of the negative pressure wound therapy (NPWT) in patients treated with open abdomen technique? A systematic review and meta-analysis. J Trauma Acute Care Surg. 2016;81:575–84.

    PubMed  Google Scholar 

  5. Rodriguez JR, Razo AO, Targarona J, et al. Debridement and closed packing for sterile or infected necrotizing pancreatitis: insights into indications and outcomes in 167 patients. Ann Surg. 2008;247:294–9.

    PubMed  PubMed Central  Google Scholar 

  6. van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010;362:1491–502.

    PubMed  Google Scholar 

  7. 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;62:102–11.

    PubMed  Google Scholar 

  8. Traverso LW, Kozarek RA. Pancreatic necrosectomy: definitions and technique. J Gastrointest Surg. 2005;9:436–9.

    PubMed  Google Scholar 

  9. Hollemans RA, Bakker OJ, Boermeester MA, et al. Superiority of step-up approach vs open necrosectomy in long-term follow-up of patients with necrotizing pancreatitis. Gastroenterology. 2019;156:1016–26.

    PubMed  Google Scholar 

  10. Yokoe M, Yakada T, Mayumi T, et al. Japanese guidelines for the management of acute pancreatitis: Japanese guidelines 2015. J Hepatobiliary Pancreat Sci. 2015;6:405–32.

    Google Scholar 

  11. Howard TJ, Patel JB, Zyromski N, et al. Declining morbidity and mortality rates in the surgical management of pancreatic necrosis. J Gastrointest Surg. 2007;11:43–9.

    PubMed  Google Scholar 

  12. van Santvoort HC, Besselink MG, Horvath KD, et al. Videoscopic assisted retroperitoneal debridement in infected necrotizing pancreatitis. HPB. 2007;9:156–9.

    PubMed  PubMed Central  Google Scholar 

  13. Van Brunschot S, van Grinsven J, van Santvoort HC, et al. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. Lancet (London, England). 2018;391:51–8.

    Google Scholar 

  14. Luca S, Osvaldo C, Massimiliano M, et al. Combined totally mini-invasive approach in necrotizing pancreatitis: a case report and systematic literature review. World J Emerg Surg. 2017;12:16.

    Google Scholar 

  15. Venturi ML, Attinger CE, Mesbahi AN, et al. Mechanisms and clinical applications of the vacuum-assisted closure (VAC) device: a review. Am J Clin Dermatol. 2005;6:185–94.

    PubMed  Google Scholar 

  16. Jacobs S, Simhaee DA, Marsano A, et al. Efficacy and mechanisms of vacuum-assisted closure (VAC) therapy in promoting wound healing: a rodent model. J Plast Reconstr Aesthet Surg. 2009;62:1331–8.

    PubMed  Google Scholar 

  17. Kairinos N, Voogd AM, Botha PH, et al. Negative-pressure wound therapy II: negative-pressure wound therapy and increased perfusion. Just an illusion? Plast Reconstr Surg. 2009;123:601–12.

    CAS  PubMed  Google Scholar 

  18. Orgill DP, Manders EK, Sumpio BE, et al. The mechanisms of action of vacuum assisted closure: more to learn. Surgery. 2009;146:40–51.

    PubMed  Google Scholar 

  19. Ito E, Yoshida M, Ohdaira H, et al. Case series of in situ pelvic floor reconstruction combining levator ani suture and negative pressure wound therapy for abdominoperineal resection. Ann Med Surg. 2012;2019(43):64–7.

    Google Scholar 

  20. Borgquist O, Gustafsson L, Ingemansson R, et al. Micro- and macromechanical effects on the wound bed of negative pressure wound therapy using gauze and foam. Ann Plast Surg. 2010;64:789–93.

    CAS  PubMed  Google Scholar 

  21. Atema JJ, Gans SL, Boermeester MA. Systematic review and meta-analysis of the open abdomen and temporary abdominal closure techniques in non-trauma patients. World J Surg. 2015;39:912–25.

    CAS  PubMed  Google Scholar 

  22. Coccolini F, Roberts D, Ansaloni L, et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J Emerg Surg. 2018;13:7.

    PubMed  PubMed Central  Google Scholar 

  23. Olejnik J, Vokurka J, Vician M. Acute necrotizing pancreatitis: intra-abdominal vacuum sealing after necrosectomy. Hepatogastroenterology. 2008;55:315–8.

    PubMed  Google Scholar 

  24. Kirkpatrick AW, Roberts DJ, Faris PD, et al. Active negative pressure peritoneal therapy after abbreviated laparotomy: the intraperitoneal vacuum randomized controlled trial. Ann Surg. 2015;262:38–46.

    PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank Editage (www.editage.jp) for the English language review.

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Authors and Affiliations

  1. Department of Gastroenterological-Breast and Transplant Surgery, Hiroshima Prefectural Hospital, 1-5-54 U**a-kanda, Minami-ku, Hiroshima, 734-8530, Japan

    Yosuke Namba, Yasuhiro Matsugu & Toshiyuki Itamoto

  2. Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Yasuhiro Matsugu & Toshiyuki Itamoto

  3. Department of Gastroenterology, Hiroshima Prefectural Hospital, Hiroshima, Japan

    Masaru Furukawa & Tamito Sasaki

  4. Department of Gastroenterology and Metabolism, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Maiko Namba & Tamito Sasaki

Authors
  1. Yosuke Namba
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  2. Yasuhiro Matsugu
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  3. Masaru Furukawa
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  4. Maiko Namba
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  5. Tamito Sasaki
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  6. Toshiyuki Itamoto
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Correspondence to Yasuhiro Matsugu.

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Yosuke Namba, Yasuhiro Matsugu, Masaru Furukawa, Maiko Namba, Tamito Sasaki, and Toshiyuki Itamoto declare that they have no conflict of interest.

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Namba, Y., Matsugu, Y., Furukawa, M. et al. Step-up approach combined with negative pressure wound therapy for the treatment of severe necrotizing pancreatitis: a case report. Clin J Gastroenterol 13, 1331–1337 (2020). https://doi.org/10.1007/s12328-020-01190-9

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  • DOI: https://doi.org/10.1007/s12328-020-01190-9

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