Minimally invasive and standard operative techniques in the surgical treatment of acute complicated pancreatitis

Abstract

The surgical treatment of acute pancreatitis, particularly the choice of operative technique, is becoming increasingly relevant.

Objective — to develop a surgical approach for treating patients with acute complicated pancreatitis by determining the effectiveness of minimally invasive and traditional operative techniques, both independently and in combination.

Materials and methods. Surgical treatment was performed on 170 patients with acute complicated pancreatitis. In the main group (Group M) — 109 patients were predominantly treated with minimally invasive techniques (MITs), while in the comparative group (Group C) — 61 patients underwent standard operations. The age of hospitalized patients ranged from 22 to 74 years, including 36 women (33%) and 73 men (67%).

Results. MITs were performed as «final» in 62 cases (69%), «staged» in 16 cases (18%), and «stabilizing» in 12 cases (13%). The number of combined interventions was higher in Group M — 26% versus 12% in Group C (p=0.04), while standard operations dominated in Group C — 67% compared to 17% in Group M (p <0.0001). Primary laparotomy was performed in 41 patients (67%) in Group C and 19 patients (17%) in Group M (p <0.0001). The volume of standard operations in Group M mainly consisted of necrosectomy and the Beger procedure, including closed drainage — 26 cases (55%) and 15 cases (31%), respectively. Necrosectomy with subsequent staged debridement for general purulent‑necrotic lesions did not differ statistically between the groups — 11 cases (23%) and 13 cases (26%) (p >0.05).

Conclusions. The developed approach to the surgical treatment of acute complicated pancreatitis with the independent and combined use of MITs and standard operations demonstrated a tendency to reduce the frequency of postoperative complications and postoperative mortality rates — from 13.1% to 8.3% and from 14.8% to 9.2%, respectively.