Manejo en los pacientes con pancreatitis necrotizante aguda

Santiago Andrés Muñoz Palomeque; Jorge Orellana Fernández; Jeffrey Mogrovejo Mosquera

doi:10.47464/MetroCiencia/vol31/4/2023/51-60

Authors

Santiago Muñoz-Palomeque Hospital Metropolitano https://orcid.org/0000-0001-8040-4379
Jorge Orellana Fernández Red Complementaria de Salud https://orcid.org/0000-0001-9224-1108
Jeffrey Mogrovejo Mosquera Red Complementaria de Salud https://orcid.org/0000-0003-4655-4124

DOI:

https://doi.org/10.47464/MetroCiencia/vol31/4/2023/51-60

Keywords:

Pancreatitis Acute Necrotizing, Surgical Procedures Operative, Therapeutics

Abstract

Introduction: Necrotizing pancreatitis is a complication of acute pancreatitis in 12% to 25% of cases. The present analysis sought to identify the most effective and beneficial procedures at present for the management of this complication. Methodology: A systematic literature review was carried out in the “PubMed”, “Google Scholar”, “Cochrane” and “MedScape” databases, selecting articles published between 2015 and 2017, retrospective, performed in patients with necrotizing pancreatitis. Results: 8 studies of the 35 finally reviewed were included. 65.12% of cases suggest that should be initiated with a minimally invasive intervention before resorting to open necrosectomy; 55.9% of the cases coincide with the existence of greater advantages regarding the "step-up approach"; and in 27.67%, it is evidenced that "four-step approach" is effective and reduced risks and complications compared to other "step-up" strategies. In 9.22% of the cases, open necrosectomy had greater complications than the minimally invasive procedure, coinciding with the fact that in 30.81% of the cases, Marshall's score, multiorgan dysfunction syndrome, preoperative respiratory infection, sepsis, preoperative systemic inflammatory response syndrome and increased levels of C-reactive protein, are associated with postoperative complications. Conclusions: For the management of necrotizing pancreatitis, it should be initiated in the first phase with conventional treatment and specific antibiotics in case of infection. In the second phase, if the patient becomes complicated, the step-up approach will be performed (four step approach). If it fails, open necrosectomy with closed packing will be used, always considering the possible complications of this procedure.

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Author Biographies

Santiago Muñoz-Palomeque, Hospital Metropolitano

Médico Posgradista de Cirugía General. Hospital Metropolitano de Quito-Ecuador. Universidad Internacional del Ecuador
Jorge Orellana Fernández, Red Complementaria de Salud

Red Complementaria de Salud. Cuenca, Ecuador
Jeffrey Mogrovejo Mosquera, Red Complementaria de Salud

Red Complementaria de Salud. Cuenca, Ecuador

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