Vieille T, Crotet M, Turco C, Monasterolo P, Winiszewski H, Piton G. Should we perform decompressive laparotomy during severe acute pancreatitis with intra-abdominal hypertension below 25 mmHg: Only the gut knows. World J Gastrointest Surg 2024; 16(5): 1470-1473 [PMID: 38817286 DOI: 10.4240/wjgs.v16.i5.1470]
Corresponding Author of This Article
Thibault Vieille, MD, Doctor, Medical Intensive Care Unit, Besancon University Hospital, 3 bd Fleming, Besancon 25000, France. thibault.vieille91@gmail.com
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. May 27, 2024; 16(5): 1470-1473 Published online May 27, 2024. doi: 10.4240/wjgs.v16.i5.1470
Should we perform decompressive laparotomy during severe acute pancreatitis with intra-abdominal hypertension below 25 mmHg: Only the gut knows
Thibault Vieille, Melissa Crotet, Celia Turco, Paul Monasterolo, Hadrien Winiszewski, Gael Piton
Thibault Vieille, Hadrien Winiszewski, Gael Piton, Medical Intensive Care Unit, Besancon University Hospital, Besancon 25000, France
Melissa Crotet, Intensive Care Unit, Vesoul Hospital, Vesoul 70000, France
Celia Turco, Department of Digestive Surgical Oncology-Liver Transplantation Unit, Besancon University Hospital, Besancon 25000, France
Celia Turco, Inserm UMRS-938, Centre de Recherche Saint-Antoine (CRSA), Sorbonne Université, Paris 10041NY212, France
Paul Monasterolo, Intensive Care Unit, Nord Franche Comte Hospital, Trevenans 90400, France
Author contributions: Vieille T and Piton G drafted the manuscript; Crotet M, Turco C, Monasterolo P, and Winiszewski H have re-viewed the manuscript and consistently improved its content; and all authors read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Thibault Vieille, MD, Doctor, Medical Intensive Care Unit, Besancon University Hospital, 3 bd Fleming, Besancon 25000, France. thibault.vieille91@gmail.com
Received: December 16, 2023 Revised: March 11, 2024 Accepted: April 15, 2024 Published online: May 27, 2024 Processing time: 158 Days and 18.8 Hours
Abstract
We suggest that during severe acute pancreatitis (SAP) with intra-abdominal hypertension, practitioners should consider decompressive laparotomy, even with intra-abdominal pressure (IAP) below 25 mmHg. Indeed, in this setting, non-occlusive mesenteric ischemia (NOMI) may occur even with IAP below this cutoff and lead to transmural necrosis if abdominal perfusion pressure is not promptly restored. We report our experience of 18 critically ill patients with SAP having undergone decompressive laparotomy of which one third had NOMI while IAP was mostly below 25 mmHg.
Core Tip: In a recent review, Nasa et al discussed the optimal timing for decompressive laparotomy during severe acute pancreatitis. In line with the authors, we think that practitioners should not only focus on intra-abdominal pressure (IAP) levels to consider laparotomy but should also consider the gut viability. Indeed, intra-abdominal hypertension may decrease bowel perfusion pressure and precipitate non-occlusive mesenteric ischemia even with IAP below 25 mmHg. The objective of decompressive laparotomy is to restore mesenteric blood flow and prevent from transmural necrosis from occurring.
