Features of the application of mini-invasive echo-controlled percutaneous interventions in patients with a complicated course of acute pancreatitis

Abstract

Among the causes of death of patients with severe acute pancreatitis, purulent-septic complications take the first place, occurring in 40% of cases of the disease [1]. Currently, a staged approach to the surgical treatment of patients with acute pancreatitis is generally recognized, with the maximum postponement of traditional open surgical interventions and the use of minimally invasive treatment methods in the case of a complicated course of the disease [2]. However, mini-invasive percutaneous echo-controlled puncture drainage interventions have certain limitations in case of location of local complications of acute pancreatitis of the right and central-right type due to the high risk of iatrogenic injuries as a result of possible uncontrolled advancement of the working part of the device [3]. The purpose of the study was to improve the results of surgical treatment of patients with acute pancreatitis through the introduction of improved techniques of miniinvasive percutaneous echo-controlled interventions in complicated course of the disease. Materials and methods of research. The study was based on the results of examination of 187 patients with severe acute pancreatitis, who were divided into two groups: a comparison group – patients who used traditional methods of examination and treatment (n=92) and the main group – patients who used improved surgical tactics (n=95). To assess the effectiveness of surgical tactics in the studied groups, a comparative analysis of the applied methods, the frequency of postoperative complications, mortality, and the duration of hospitalization was carried out. Results of the research. The introduction of improved miniinvasive percutaneous echo-controlled surgical interventions expanded the possibilities of their use, including in the localization of infected local complications of the right and central-right type, and probably increased their effectiveness by 41.8% (p=0.02). A comparative analysis of the duration of inpatient treatment in the studied groups revealed a probable reduction in the terms of hospitalization of patients in the main group by 14.7 days (р=0.0008), of which in the intensive care unit – by 4.7 days (р<0.0001). Conclusion. When comparing the results of complex treatment of patients with local complications of acute pancreatitis, it was found that the introduction of improved methods of diagnosis and treatment in patients of the main group made it possible to reliably reduce the frequency of postoperative complications by 28% (χ2=8.48, 95% CI 9.25 -44.47, p=0.003). Comparing the frequency of total postoperative mortality in the studied groups, there is a probable decrease of this indicator in the main group against the background of the use of complex treatment by 27.7% (χ2=7.66, 95% CI 8.27-44.64, p=0.005). References: 1. Baron TH, DiMaio CJ, Wang AY, Morgan KA. American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis. Gastroenterology. 2020 Jan;158(1):67-75.e1. doi: 10.1053/j.gastro.2019.07.064 2. Kolosovych IV, Bezrodnyi BH, Hanol IV, Cherepenko IV. Stage approach in surgical treatment of acute pancreatitis. Med. perspekt. 2020Jul.1; 25(2):124-9. https://doi.org/10.26641/2307-0404.2020.2.206384 3. Bansal A, Gupta P, Singh AK, Shah J, Samanta J, Mandavdhare HS, Sharma V, Sinha SK, Dutta U, Sandhu MS, Kochhar R. Drainage of pancreatic fluid collections in acute pancreatitis: A comprehensive overview. World J Clin Cases. 2022 Jul 16;10(20):6769-6783. doi: 10.12998/wjcc.v10.i20.6769