Abstract：
OBJECTIVE: Surgical transgastric pancreatic necrosectomy (STGN) has the potential to overcome the shortcomings (ie, repeat interventions, prolonged hospitalization) of the step-up approach for infected necrotizing pancreatitis. We aimed to determine the outcomes of STGN for infected necrotizing pancreatitis.
METHODS: This observational cohort study included adult patients who underwent STGN for infected necrosis at two centers from 2008 to 2022. Patients with a procedure for pancreatic necrosis before STGN were excluded. Primary outcomes included mortality, length of hospital and intensive care unit (ICU) stay, new-onset organ failure, repeat interventions, pancreatic fistulas, readmissions, and time to episode closure.
RESULTS: Forty-three patients underwent STGN at a median of 48 days (interquartile range [IQR] 32-70) after disease onset. Mortality rate was 7% (n = 3). After STGN, the median length of hospital was 8 days (IQR 6-17), 23 patients (53.5%) required ICU admission (2 days [IQR 1-7]), and new-onset organ failure occurred in 8 patients (18.6%). Three patients (7%) required a reintervention, 1 (2.3%) developed a pancreatic fistula, and 11 (25.6%) were readmitted. The median time to episode closure was 11 days (IQR 6-22).
CONCLUSIONS: STGN allows for treatment of retrogastric infected necrosis in one procedure and with rapid episode resolution. With these advantages and few pancreatic fistulas, direct STGN challenges the step-up approach.
METHODS: This observational cohort study included adult patients who underwent STGN for infected necrosis at two centers from 2008 to 2022. Patients with a procedure for pancreatic necrosis before STGN were excluded. Primary outcomes included mortality, length of hospital and intensive care unit (ICU) stay, new-onset organ failure, repeat interventions, pancreatic fistulas, readmissions, and time to episode closure.
RESULTS: Forty-three patients underwent STGN at a median of 48 days (interquartile range [IQR] 32-70) after disease onset. Mortality rate was 7% (n = 3). After STGN, the median length of hospital was 8 days (IQR 6-17), 23 patients (53.5%) required ICU admission (2 days [IQR 1-7]), and new-onset organ failure occurred in 8 patients (18.6%). Three patients (7%) required a reintervention, 1 (2.3%) developed a pancreatic fistula, and 11 (25.6%) were readmitted. The median time to episode closure was 11 days (IQR 6-22).
CONCLUSIONS: STGN allows for treatment of retrogastric infected necrosis in one procedure and with rapid episode resolution. With these advantages and few pancreatic fistulas, direct STGN challenges the step-up approach.
摘要：
目的：外科经胃胰腺坏死切除术（STGN）具有克服缺点的潜力（即，重复干预，延长住院时间）感染坏死性胰腺炎的加强方法。我们旨在确定STGN治疗感染性坏死性胰腺炎的结果。
方法：这项观察性队列研究包括2008年至2022年在两个中心接受STGN感染坏死的成年患者。排除在STGN之前进行胰腺坏死手术的患者。主要结果包括死亡率，住院和重症监护病房(ICU)住院时间，新发器官衰竭,重复干预，胰瘘,再入院,还有时间结束。
结果：43例患者在发病后中位48天（四分位距[IQR]32-70）接受STGN。死亡率为7%(n=3)。STGN之后,中位住院时间为8天（IQR6-17），23名患者（53.5%）需要入住ICU（2天[IQR1-7]），8例(18.6%)出现新发器官衰竭。三名患者（7%）需要再次干预，1例（2.3%）发生胰瘘，11例（25.6%）再次入院。发作结束的中位时间为11天（IQR6-22）。
结论：STGN允许在一个程序中治疗胃后感染坏死，并迅速消除发作。有了这些优势和很少的胰腺瘘，直接STGN对升级方法提出了挑战。
方法：这项观察性队列研究包括2008年至2022年在两个中心接受STGN感染坏死的成年患者。排除在STGN之前进行胰腺坏死手术的患者。主要结果包括死亡率，住院和重症监护病房(ICU)住院时间，新发器官衰竭,重复干预，胰瘘,再入院,还有时间结束。
结果：43例患者在发病后中位48天（四分位距[IQR]32-70）接受STGN。死亡率为7%(n=3)。STGN之后,中位住院时间为8天（IQR6-17），23名患者（53.5%）需要入住ICU（2天[IQR1-7]），8例(18.6%)出现新发器官衰竭。三名患者（7%）需要再次干预，1例（2.3%）发生胰瘘，11例（25.6%）再次入院。发作结束的中位时间为11天（IQR6-22）。
结论：STGN允许在一个程序中治疗胃后感染坏死，并迅速消除发作。有了这些优势和很少的胰腺瘘，直接STGN对升级方法提出了挑战。
