TY - JOUR
T1 - Cyst Gastrostomy and Necrosectomy for the Management of Sterile Walled-Off Pancreatic Necrosis
T2 - a Comparison of Minimally Invasive Surgical and Endoscopic Outcomes at a High-Volume Pancreatic Center
AU - Khreiss, Mohammad
AU - Zenati, Mazen
AU - Clifford, Amber
AU - Lee, Kenneth K.
AU - Hogg, Melissa E.
AU - Slivka, Adam
AU - Chennat, Jennifer
AU - Gelrud, Andres
AU - Zeh, Herbert J.
AU - Papachristou, Georgios I.
AU - Zureikat, Amer H.
N1 - Publisher Copyright:
© 2015, The Society for Surgery of the Alimentary Tract.
PY - 2015/8/25
Y1 - 2015/8/25
N2 - Introduction: Walled-off pancreatic necrosis (WON) is a sequela of acute necrotizing pancreatitis in 15–40 % of cases. We sought to compare the outcomes of minimally invasive surgical and endoscopic cyst gastrostomy (CG) and necrosectomy for the management for sterile WON at a tertiary care high-volume pancreas center. Method: This is a retrospective review of patients who underwent minimally invasive surgical or endoscopic CG and necrosectomy for clinically sterile WON between 2008 and 2013. Peri-procedural outcomes including costs were analyzed and compared. Results: Twenty patients underwent minimally invasive surgical (robotic = 14, laparoscopic = 6) CG and necrosectomy, and 20 patients underwent endoscopic treatment. The surgical cohort had a larger median cyst size and higher CCI score. For the surgical cohort, median OR time was 167.5 min, estimated blood loss was 30 ml, and 65 % underwent concomitant cholecystectomy. There was no mortality in either group and no difference in complication rates (20 %). The failure rate was similar (15 versus 10 %, P = 0.66). Although surgery was associated with a lower re-intervention rate (0 versus 1, P = 0.008), the endotherapy group was associated with shorter total LOS (inclusive of re-interventions) (7 versus 3 days, P = 0.032). The cost of the index procedure was significantly higher for the surgery group (P = 0.014); however, when considering all readmissions and re-interventions until resolution of the WON, the total cost was similar for both groups. Conclusion: Minimally invasive surgical and endoscopic CG and necrosectomy are comparable treatments for sterile WON in terms of outcomes and overall cost. The surgical approach may be considered advantageous when a concomitant cholecystectomy is required.
AB - Introduction: Walled-off pancreatic necrosis (WON) is a sequela of acute necrotizing pancreatitis in 15–40 % of cases. We sought to compare the outcomes of minimally invasive surgical and endoscopic cyst gastrostomy (CG) and necrosectomy for the management for sterile WON at a tertiary care high-volume pancreas center. Method: This is a retrospective review of patients who underwent minimally invasive surgical or endoscopic CG and necrosectomy for clinically sterile WON between 2008 and 2013. Peri-procedural outcomes including costs were analyzed and compared. Results: Twenty patients underwent minimally invasive surgical (robotic = 14, laparoscopic = 6) CG and necrosectomy, and 20 patients underwent endoscopic treatment. The surgical cohort had a larger median cyst size and higher CCI score. For the surgical cohort, median OR time was 167.5 min, estimated blood loss was 30 ml, and 65 % underwent concomitant cholecystectomy. There was no mortality in either group and no difference in complication rates (20 %). The failure rate was similar (15 versus 10 %, P = 0.66). Although surgery was associated with a lower re-intervention rate (0 versus 1, P = 0.008), the endotherapy group was associated with shorter total LOS (inclusive of re-interventions) (7 versus 3 days, P = 0.032). The cost of the index procedure was significantly higher for the surgery group (P = 0.014); however, when considering all readmissions and re-interventions until resolution of the WON, the total cost was similar for both groups. Conclusion: Minimally invasive surgical and endoscopic CG and necrosectomy are comparable treatments for sterile WON in terms of outcomes and overall cost. The surgical approach may be considered advantageous when a concomitant cholecystectomy is required.
KW - Cyst gastrostomy
KW - Necrosectomy
KW - Necrotizing pancreatitis
KW - Pancreatic debridement
KW - Walled-off pancreatic necrosis
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U2 - 10.1007/s11605-015-2864-6
DO - 10.1007/s11605-015-2864-6
M3 - Article
C2 - 26033038
AN - SCOPUS:84937971772
SN - 1091-255X
VL - 19
SP - 1441
EP - 1448
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 8
ER -