Published online Apr 27, 2019. doi: 10.4240/wjgs.v11.i4.198
Peer-review started: March 15, 2019
First decision: April 13, 2019
Revised: April 19, 2019
Accepted: April 23, 2019
Article in press: April 23, 2019
Published online: April 27, 2019
Incidence of acute pancreatitis seems to be increasing in the Western countries and has been associated with significantly increased morbidity. Nearly 80% of the patients with acute pancreatitis undergo resolution; some develop complications including pancreatic necrosis. Infection of pancreatic necrosis is the leading cause of death in these patients. A significant portion of these patients needs surgical interventions. Traditionally, the “gold standard” procedure has been the open surgical necrosectomy, which is now being completed by the relatively lesser invasive interventions. Minimally invasive surgical (MIS) procedures include endoscopic drainage, percutaneous image-guided catheter drainage, and retroperitoneal drainage. This review article discusses the open and MIS interventions for pancreatic necrosis with each having its own respective benefits and disadvantages are covered.
Core tip: Pancreatic necrosis is one of the serious complications of acute pancreatitis. A significant portion of these patients needs surgical interventions. Traditionally, the “gold standard” procedure has been the open surgical necrosectomy, which is now being completed by the relatively lesser invasive interventions which include endoscopic drainage, percutaneous image-guided catheter drainage, and retroperitoneal drainage which are discussed in detail in this review article. However, no single modality is optimal for the treatment, and a multi-modal approach is needed. The mainstay of the management is now shifting to a “Step-up approach” from the most non-invasive towards the most invasive techniques in a step-up manner as the indications arise.