Ultrasound-guided percutaneous surgical techniques as a definitive treatment for acute infected necrotizing pancreatitis

Abstract

OBJECTIVE – to identify clinical, laboratory, and imaging predictors for open necrosequestrectomy in patients with acute infected necrotizing pancreatitis (AINP). MATERIALS AND METHODS. A retrospective cohort study involving 188 patients with local AINP complications was conducted in a specialized surgical department from 2018 to 2023. All patients had ultrasound-guided percutaneous drainage. Patients were divided into two groups based on the effectiveness of ultrasound-guided minimally invasive surgery (MIS): those receiving ultrasound-guided MIS as a definitive treatment and those undergoing ultrasound-guided MIS combined with open necrosequestrectomy. Clinical severity, CT index, comorbidities, laboratory parameters, and bacteriological culture results were analyzed. Statistical significance was assessed using the t-test, 2 test, and odds ratio (OR). RESULTS. Ultrasound-guided MIS was an effective definitive treatment in 127 (67.5 %) patients. Open surgery was required for 61 (32.4 %) patients. Statistically significant risk factors for resorting to open surgery included a dense tissue component in the drainage area (OR = 0.08), hemorrhagic effusion (OR = 0.07), hypoalbuminemia (OR = 0.09), anemia (OR = 0.16), platelet abnormalities (OR = 0.13), and early laparotomy (OR = 0.09). Mortality in the ultrasound-guided MIS group was 9.6 %, whereas in the open surgery group it was 29.5 % (p < 0.05). CONCLUSIONS. Ultrasound-guided minimally invasive drainage procedures are an effective and safe treatment for the majority of patients with infected necrotizing pancreatitis. The identified clinical and laboratory predictors serve as indications for open surgery.