Cyst Gastrostomy and Necrosectomy for the Management of Sterile Walled-Off Pancreatic Necrosis: a Comparison of Minimally Invasive Surgical and Endoscopic Outcomes at a High-Volume Pancreatic Center

Mohammad Khreiss, Mazen Zenati, Amber Clifford, Kenneth K. Lee, Melissa E. Hogg, Adam Slivka, Jennifer Chennat, Andres Gelrud, Herbert J. Zeh, Georgios I. Papachristou, Amer H. Zureikat

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1441-1448
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume19
Issue number8
DOIs
StatePublished - Aug 25 2015
Externally publishedYes

Fingerprint

Gastrostomy
Cysts
Necrosis
Costs and Cost Analysis
Cholecystectomy
Acute Necrotizing Pancreatitis
Robotics
Tertiary Healthcare
Pancreas
Mortality
Therapeutics

Keywords

  • Cyst gastrostomy
  • Necrosectomy
  • Necrotizing pancreatitis
  • Pancreatic debridement
  • Walled-off pancreatic necrosis

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Cyst Gastrostomy and Necrosectomy for the Management of Sterile Walled-Off Pancreatic Necrosis : a Comparison of Minimally Invasive Surgical and Endoscopic Outcomes at a High-Volume Pancreatic Center. / Khreiss, Mohammad; Zenati, Mazen; Clifford, Amber; Lee, Kenneth K.; Hogg, Melissa E.; Slivka, Adam; Chennat, Jennifer; Gelrud, Andres; Zeh, Herbert J.; Papachristou, Georgios I.; Zureikat, Amer H.

In: Journal of Gastrointestinal Surgery, Vol. 19, No. 8, 25.08.2015, p. 1441-1448.

Research output: Contribution to journalArticle

Khreiss, Mohammad ; Zenati, Mazen ; Clifford, Amber ; Lee, Kenneth K. ; Hogg, Melissa E. ; Slivka, Adam ; Chennat, Jennifer ; Gelrud, Andres ; Zeh, Herbert J. ; Papachristou, Georgios I. ; Zureikat, Amer H. / Cyst Gastrostomy and Necrosectomy for the Management of Sterile Walled-Off Pancreatic Necrosis : a Comparison of Minimally Invasive Surgical and Endoscopic Outcomes at a High-Volume Pancreatic Center. In: Journal of Gastrointestinal Surgery. 2015 ; Vol. 19, No. 8. pp. 1441-1448.
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abstract = "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.",
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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.

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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.

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KW - Necrosectomy

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KW - Pancreatic debridement

KW - Walled-off pancreatic necrosis

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