Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2017; 9(10): 200-208
Published online Oct 27, 2017. doi: 10.4240/wjgs.v9.i10.200
Mortality and morbidity in necrotizing pancreatitis managed on principles of step-up approach: 7 years experience from a single surgical unit
Deshpande Aparna, Sunil Kumar, Shukla Kamalkumar
Deshpande Aparna, Sunil Kumar, Shukla Kamalkumar, Department of Surgery, Seth G.S.Medical College and K.E.M. Hospital, Parel, Mumbai 400012, India
Author contributions: Aparna D contributed to data collection, analysis, manuscript preparation and review; Kumar S contributed to data collection, tabulation, analysis; Kamalkumar S contributed to manuscript preparation, review.
Institutional review board statement: This was a retrospective review of existing database of patients hence a waiver from Institutional review board was requested for and was granted. Statement of the same is uploaded.
Informed consent statement: No informed consent document is available as this is a retrospective review of database. Care has been taken not to disclose identity of any patient.
Conflict-of-interest statement: None.
Data sharing statement: As this is a retrospective analysis of an existing database, there is no data sharing statement.
Open-Access: 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/
Correspondence to: Dr. Deshpande Aparna, Professor, Department of Surgery, Seth G.S.Medical College and K.E.M. Hospital, Acharya Donde Marg, Parel, Mumbai 400012, India. aparnadeshpande@kem.edu
Telephone: +91-98-20231568
Received: December 23, 2016
Peer-review started: December 28, 2016
First decision: January 14, 2017
Revised: July 31, 2017
Accepted: August 16, 2017
Article in press: August 17, 2017
Published online: October 27, 2017
Processing time: 306 Days and 12.4 Hours
Core Tip

Core tip: Necrotizing pancreatitis is a clinical challenge which requires aggressive conservative management in the early part of the attack. About 60% patients respond to conservative management. Patients who develop infection in the necrosis may require intervention. Delay, drain and debride if required, are the principles of step-up approach. Percutaneous drainage should be performed to be followed later by a step-up necrosectomy if required. If percutaneous drainage is not available or is technically unfeasible, surgical necrosectomy can yield equally good results when performed after an appropriate delay at least of 2 wk. With advent of minimally invasive modalities, infected as well as symptomatic sterile necrosis can be treated variably with radiological, surgical or endoscopic means. The modality selected depends upon the local morphology of the inflamed pancreas and availability of expertise.