- Email: [email protected]
Preoperative splenic embolization for disconnected pancreatic duct syndrome in the management of acute necrotizing pancreatitis
e322
Electronic Poster Abstracts
severity. Atlanta 2010 Consensus recommended Marshall score to assess severity of acute pancreatitis. Objective: To determine the association between APACHE II score, Marshall score and PCR at admission, with the requirement of Critical Care Unit (CCU) and mortality. Methods: Prospective cohort of patients with acute pancreatitis at Hospital Temuco, between 2013 and 2014. Biodemographic variables were recorded, APACHE II score, Marshall score and CPR at Emergency admission and at CCU. Descriptive statistics were used with measures of central tendency and dispersion. Results: Cohort of 268 patients, mean of age 52.12 19.97 years, 66% female. APACHE II score, CPR and Marshall score at admission was 5.86 4.24, 73.77 94 and 0.36 0.84, respectively; 18% with requeriment of CCU admission. Seven patients (3%) required surgery/percutaneous drainage by local complications. The mortality rate was 2%. The APACHE II score, Marshall score and value of CRP at admission showed association with CCU admission (APACHE II p < 0.001; PCR p < 0.001; Marshall p < 0.001). The APACHE II score and CRP at admission showed no association with mortality (APACHE II p = 0.0039; p = 0.022 CPR). Conclusions: APACHE II score and CRP showed association with requirement of admission to CCU and mortality. The Marshall score only showed association with the requirement of admission to CCU.
EP02A-009 MANAGEMENT OF PANCREATIC PSEUDOCYSTS DUE TO ACUTE PANCREATITIS BY PERCUTANEOUS ASPIRATION: EARLY INTERVENTION CAN MINIMIZE NEED FOR CYSTOENTEROSTOMY R. Mohan, S. Naik and G. S. Anantharaju Department of Surgery, SDM College of Medical Sciences & Hospital, India Introduction: Current management of Pancreatic Pseudocysts involves assessment at 6 weeks followed by endoscopic or surgical Cysto-Enterostomy. We describe a protocol of serial evaluation and early percutaneous aspiration. Methods: We retrospectively analyze Pancreatic Pseudocysts managed by us from July 2011 to June 2015. All patients underwent a baseline Computed Tomography, followed by re-evaluation by Ultra Sonography [USG] whenever clinically indicated, or at 3 weeks if there was clinical resolution of symptoms. The patients with a pancreatic pseudocyst underwent immediate aspiration under USG guidance. These patients who underwent aspiration were reassessed by USG at 6 weeks, 9 weeks and 12 weeks. They underwent re-aspiration if there was persistence of the pseudocyst by a volume greater than 50% of previous volume. Persistence of the pseudocyst at 12 weeks, with a volume greater than 50% of volume at initial assessment was considered an indication for Cysto-Enterostomy. Results: During the period of 48 months, we managed 429 cases of Acute Pancreatitis [excluding Chronic Pancreatitis]. 97 patients were noted to have Pancreatic Pseudocysts on USG evaluation at 3 weeks, and underwent
immediate aspiration. At 6 weeks, 23 patients required reaspiration, and at 9 weeks 13 patients required a third aspiration. At 12 weeks 9 patients were found to have persistence of the pseudocyst and underwent Cysto-Enterostomy. There was no mortality in this group of patients. Conclusions: Early re-assessment and percutaneous aspiration can minimize need for Cysto-Enterostomy. We recommend an early intervention protocol of aspiration at 3 weeks in patients with Acute Pancreatitis with Pseudocysts.
EP02A-010 PREOPERATIVE SPLENIC EMBOLIZATION FOR DISCONNECTED PANCREATIC DUCT SYNDROME IN THE MANAGEMENT OF ACUTE NECROTIZING PANCREATITIS J. Cioffi, T. Fischer, R. Feezor, J. Trevino, K. Behrns and S. Hughes Department of Surgery, University of Florida, United States Introduction: Treatment strategies in the management of severe acute necrotizing pancreatitis have changed dramatically in the past decade. At our institution, the development of long-segment disconnected pancreatic duct syndrome (DPDS) in the setting of acute necrotizing pancreatitis (ANP) or pseudocyst with persistent duct disruption with a viable tail is an indication for surgical necrosectomy. We have utilized pre-operative splenic artery embolization (SAE) as an adjunct to improve perioperative morbidity. Methods: A retrospective review of patients with ANP treated at a single academic institution was performed to identify patients with DPDS over a 6-year period (2009e 2015). Results: 36 patients were identified with DPDS in the setting of ANP. Diagnosis was made by cross-sectional imaging. All patients underwent necrosectomy with distal pancreatectomy and splenectomy and preoperative SAE. Comparisons were made to a historical cohort with DPDS/ ANP without SAE. The etiology of pancreatitis, indications for intervention, and patient characteristics were similar between the two groups. There were no procedural complications from SAE. EBL was less with SAE (900 ml vs1450 ml; p < 0.05) with fewer blood product transfusions (3.0 units vs. 3.4units). Overall morbidity was 44% with 0% mortality and significantly reduced clinically significant POPF (22% vs. 36%; p < 0.05). Median postoperative length of stay (11days vs. 19 days) and 30-day readmission rates (27% vs. 39%) were also reduced. Conclusions: Preoperative splenic embolization for DPDS in ANP is effective at reducing morbidity, blood loss, and clinically significant POPF associated with open necrosectomy.
EP02A-011 EARLY VERSUS DELAYED CHOLECYSTECTOMY IN PATIENTS WITH ACUTE BILIARY PANCREATITIS B. Devkaran1 and N. K. Vijhay Ganesun2 1 Surgery, Indira Gandhi Medical College, and 2Surgery, HP University, India HPB 2016, 18 (S1), e1ee384
Electronic Poster Abstracts
severity. Atlanta 2010 Consensus recommended Marshall score to assess severity of acute pancreatitis. Objective: To determine the association between APACHE II score, Marshall score and PCR at admission, with the requirement of Critical Care Unit (CCU) and mortality. Methods: Prospective cohort of patients with acute pancreatitis at Hospital Temuco, between 2013 and 2014. Biodemographic variables were recorded, APACHE II score, Marshall score and CPR at Emergency admission and at CCU. Descriptive statistics were used with measures of central tendency and dispersion. Results: Cohort of 268 patients, mean of age 52.12 19.97 years, 66% female. APACHE II score, CPR and Marshall score at admission was 5.86 4.24, 73.77 94 and 0.36 0.84, respectively; 18% with requeriment of CCU admission. Seven patients (3%) required surgery/percutaneous drainage by local complications. The mortality rate was 2%. The APACHE II score, Marshall score and value of CRP at admission showed association with CCU admission (APACHE II p < 0.001; PCR p < 0.001; Marshall p < 0.001). The APACHE II score and CRP at admission showed no association with mortality (APACHE II p = 0.0039; p = 0.022 CPR). Conclusions: APACHE II score and CRP showed association with requirement of admission to CCU and mortality. The Marshall score only showed association with the requirement of admission to CCU.
EP02A-009 MANAGEMENT OF PANCREATIC PSEUDOCYSTS DUE TO ACUTE PANCREATITIS BY PERCUTANEOUS ASPIRATION: EARLY INTERVENTION CAN MINIMIZE NEED FOR CYSTOENTEROSTOMY R. Mohan, S. Naik and G. S. Anantharaju Department of Surgery, SDM College of Medical Sciences & Hospital, India Introduction: Current management of Pancreatic Pseudocysts involves assessment at 6 weeks followed by endoscopic or surgical Cysto-Enterostomy. We describe a protocol of serial evaluation and early percutaneous aspiration. Methods: We retrospectively analyze Pancreatic Pseudocysts managed by us from July 2011 to June 2015. All patients underwent a baseline Computed Tomography, followed by re-evaluation by Ultra Sonography [USG] whenever clinically indicated, or at 3 weeks if there was clinical resolution of symptoms. The patients with a pancreatic pseudocyst underwent immediate aspiration under USG guidance. These patients who underwent aspiration were reassessed by USG at 6 weeks, 9 weeks and 12 weeks. They underwent re-aspiration if there was persistence of the pseudocyst by a volume greater than 50% of previous volume. Persistence of the pseudocyst at 12 weeks, with a volume greater than 50% of volume at initial assessment was considered an indication for Cysto-Enterostomy. Results: During the period of 48 months, we managed 429 cases of Acute Pancreatitis [excluding Chronic Pancreatitis]. 97 patients were noted to have Pancreatic Pseudocysts on USG evaluation at 3 weeks, and underwent
immediate aspiration. At 6 weeks, 23 patients required reaspiration, and at 9 weeks 13 patients required a third aspiration. At 12 weeks 9 patients were found to have persistence of the pseudocyst and underwent Cysto-Enterostomy. There was no mortality in this group of patients. Conclusions: Early re-assessment and percutaneous aspiration can minimize need for Cysto-Enterostomy. We recommend an early intervention protocol of aspiration at 3 weeks in patients with Acute Pancreatitis with Pseudocysts.
EP02A-010 PREOPERATIVE SPLENIC EMBOLIZATION FOR DISCONNECTED PANCREATIC DUCT SYNDROME IN THE MANAGEMENT OF ACUTE NECROTIZING PANCREATITIS J. Cioffi, T. Fischer, R. Feezor, J. Trevino, K. Behrns and S. Hughes Department of Surgery, University of Florida, United States Introduction: Treatment strategies in the management of severe acute necrotizing pancreatitis have changed dramatically in the past decade. At our institution, the development of long-segment disconnected pancreatic duct syndrome (DPDS) in the setting of acute necrotizing pancreatitis (ANP) or pseudocyst with persistent duct disruption with a viable tail is an indication for surgical necrosectomy. We have utilized pre-operative splenic artery embolization (SAE) as an adjunct to improve perioperative morbidity. Methods: A retrospective review of patients with ANP treated at a single academic institution was performed to identify patients with DPDS over a 6-year period (2009e 2015). Results: 36 patients were identified with DPDS in the setting of ANP. Diagnosis was made by cross-sectional imaging. All patients underwent necrosectomy with distal pancreatectomy and splenectomy and preoperative SAE. Comparisons were made to a historical cohort with DPDS/ ANP without SAE. The etiology of pancreatitis, indications for intervention, and patient characteristics were similar between the two groups. There were no procedural complications from SAE. EBL was less with SAE (900 ml vs1450 ml; p < 0.05) with fewer blood product transfusions (3.0 units vs. 3.4units). Overall morbidity was 44% with 0% mortality and significantly reduced clinically significant POPF (22% vs. 36%; p < 0.05). Median postoperative length of stay (11days vs. 19 days) and 30-day readmission rates (27% vs. 39%) were also reduced. Conclusions: Preoperative splenic embolization for DPDS in ANP is effective at reducing morbidity, blood loss, and clinically significant POPF associated with open necrosectomy.
EP02A-011 EARLY VERSUS DELAYED CHOLECYSTECTOMY IN PATIENTS WITH ACUTE BILIARY PANCREATITIS B. Devkaran1 and N. K. Vijhay Ganesun2 1 Surgery, Indira Gandhi Medical College, and 2Surgery, HP University, India HPB 2016, 18 (S1), e1ee384