Minimally invasive percutaneous interventions in the final stage of treatment of infected necrotizing pancreatitis. Review of recent studies

Abstract

Infected necrotizing pancreatitis represents one of the most challenging conditions in abdominal surgery and requires multi-stage minimally invasive interventions as part of the widely accepted step-up approach. This strategy involves collaboration between interventional radiologists and interventional gastroenterologists. Navigation-assisted minimally invasive interventions are crucial during the initial 3 – 4 weeks of the disease, serving as the primary method for managing infected necrotic collections in the retroperitoneal tissue.

Objective – to analyze studies published between 2020 and 2025 and evaluate the effectiveness of percutaneous interventions as the definitive treatment for acute infected pancreatitis.

The analysis indicates that navigation-assisted minimally invasive interventions are effective in 35 – 55% of cases involving infected pancreatic necrosis. The increasing effectiveness of these interventions facilitates rapid reduction of systemic intoxication and stabilization of the patient’s condition. Effectiveness is evaluated by clinical and laboratory parameters, including reductions in body temperature, leukocytosis, and C-reactive protein or procalcitonin levels within 48 – 72 hours, as well as radiological assessment of the necrotic collection volume in retroperitoneal tissue. A reduction in the size of the necrotic focus by approximately 70 – 75% within 10 – 14 days reliably predicts successful isolated drainage without the need for necrosectomy (M. Wroński et al., 2014). Clinical success rates were 67.6% in the early drainage group (up to 2 weeks) and 77.0% in the late drainage group (fourth week from disease onset). These findings support the integration of percutaneous and endoscopic methods as complementary components within a step-up strategy and underscore the necessity for further development of navigation-assisted minimally invasive percutaneous techniques for the treatment of complex infected retroperitoneal masses.