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Endoskopie heute 2006; 19(3): 153-157
DOI: 10.1055/s-2006-942251
Übersicht

© Georg Thieme Verlag Stuttgart · New York

Akute Pankreatitis: Minimalinvasiver und interventioneller Ansatz bei infizierten Pankreasnekrosen

Acute Pancreatitis: Minimal-invasive and Interventional Strategies for the Management of Infected NecrosesT. Keck1 , A. Fischer2 , D. Tittelbach-Helmrich1 , O. Schäfer3 , U. Adam1 , U. T. Hopt1
  • 1Abteilung Allgemein- und Viszeralchirurgie mit Poliklinik
  • 2Chirurgische Endoskopie, Chirurgische Universitätsklinik Freiburg
  • 3Abteilung Röntgendiagnostik, Radiologische Universitätsklinik, Freiburg im Breisgau
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Publication History

Publication Date:
12 October 2006 (online)

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Zusammenfassung

Die Nekrosektomie bei infizierten Nekrosen nach akuter Pankreatitis wurde in den vergangenen Jahren durch die Einführung einer Vielzahl von interventionellen und minimalinvasiven Techniken revolutioniert. In der vorliegenden Arbeit liefern wir eine Übersicht und Wertung des Armamentariums minimalinvasiver chirurgischer und interventioneller Techniken. Laparoskopisch-endoskopische Kombinationsverfahren und minimalinvasive Verfahren liefern viel versprechende Ergebnisse, müssen sich aber an den Ergebnissen der etablierten offenen chirurgischen Verfahren messen und erfordern eine Evaluation in größeren Serien.

Abstract

Necrosectomy of infected necroses after acute pancreatitis was revolutionized in recent years by introduction of a number of interventional and minimal invasive techniques. In the present article we review and evaluate the armamentarium of minimal invasive surgical and interventional techniques. Laparoscopic-endoscopic rendezvous manoeuvres and minimal invasive operations deliver promising results, have however to be compared to results of long standing open surgery and warrant an evaluation in larger series.

Schlüsselwörter

akute Pankreatitis - Nekrosen - minimalinvasive Chirurgie - Intervention - Übersichtsarbeit

Key words

acute pancreatitis - necrosis - minimal invasive surgery - intervention - review

Literatur

  • 1 Baron T, Thaggard W, Morgan D. et al . Endoscopic therapy for organized pancreatic necrosis.  Gastroenterology. 1996;  111 755-764
    CrossrefPubMedGoogle Scholar
  • 2 Baron T, Morgan D. Endoscopic transgastric irrigation tube placement via PEG fordebridement of organized pancreatic necrosis.  Gastrointest Endosc. 1999;  50 574-577
    CrossrefPubMedGoogle Scholar
  • 3 Beger H G, Bittner R, Block S. et al . Bacterial contamination of pancreatic necrosis. A prospective clinical study.  Gastroenterology. 1986;  91 433-438
    PubMedGoogle Scholar
  • 4 Beger H G, Buchler M, Bittner R. et al . Necrosectomy and postoperative locallavage in necrotizing pancreatitis.  Br J Surg. 1988;  75 207-212
    CrossrefPubMedGoogle Scholar
  • 5 Bosscha K, Hulstaert P F, Hennipman A. et al . Fulminant acute pancreatitis and infected necrosis: results of open management of the abdomen and “plannes” reoperations.  J Am Coll Surg. 1998;  187 255-262
    CrossrefPubMedGoogle Scholar
  • 6 Bradley 3rd  E L. A fifteen year experience with open drainage for infected pancreatic necrosis.  Surg Gynecol Obstet. 1993;  177 215-222
    PubMedGoogle Scholar
  • 7 Buchler M W, Gloor B, Muller C A. et al . Acute necrotizing pancreatitis: treatment strategy according to the status of infection.  Ann Surg. 2000;  232 619-626
    CrossrefPubMedGoogle Scholar
  • 8 Carter C, McKay C J, Imrie C. Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pacreatic necrosis: an initial experience.  Ann Surg. 2000;  232 175-180
    CrossrefPubMedGoogle Scholar
  • 9 Castellanos G, Pinero A, Serrano A. et al . Infected pancreatic necrosis: translumbar approach and management with retroperitoneoscopy.  Arch Surg. 2002;  137 1060-1062
    PubMedGoogle Scholar
  • 10 Connor S, Ghaneh P, Raraty M. et al . Minimally invasive retroperitoneal pancreatic necrosectomy.  Dig Surg. 2003;  20 270-277
    CrossrefPubMedGoogle Scholar
  • 11 Echenique A M, Sleeman D, Yrizarry J. et al . Percutaneous catheter-directed debridement of infected pancreatic necrosis: results in 20 patients.  J Vasc Interv Radiol. 1998;  9 565-571
    PubMedGoogle Scholar
  • 12 Farkas G, Marton J, Mandi Y. et al . Surgical strategy and management of inffected pancreatic necrosis.  Br J Surg. 1996;  83 930-933
    CrossrefPubMedGoogle Scholar
  • 13 Fernandez-del Castillo C, Rattner D W, Makary M A. et al . Debridement and closed packing for the treatment of necrotizing pancreatitis.  Ann Surg. 1998;  228 676-684
    CrossrefPubMedGoogle Scholar
  • 14 Freeny P C, Hauptmann E, Althaus S J. et al . Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results.  AJR Am J Roentgenol. 1998;  170 969-975
    PubMedGoogle Scholar
  • 15 Gambiez L, Denimal F, Porte H. et al . Retroperitoneal approach and endoscopic management of peripancreatic necrosis collections.  Arch Surg. 1998;  133 66-72
    PubMedGoogle Scholar
  • 16 Gmeinwieser J, Feuerbach S, Zirngibl H. et al . Percutaneous treatment of infected necrotizing pancreatitis.  Eur IHPBA. 1997;  23 575-578
    PubMedGoogle Scholar
  • 17 Gouzi J L, Bloom E, Julio C. et al . Percutaneous drainage of infected pancreatic necrosis: an alternative to surgery.  Chirurgie. 1999;  124 31-37
    CrossrefPubMedGoogle Scholar
  • 18 Horvath K, Kao L, Ali A. et al . Laparoscopic assisted percutaneous drainage of infected pancreatic necrosis.  Surg Endosc. 2001;  15 677-682
    CrossrefPubMedGoogle Scholar
  • 19 Johnson C D, Kingsnorth A N, Imrie C W. et al . Double blind, randomised, placebo controlled study of a platelet activating factor antagonist, lexipafant, in the treatment and prevention of organ failure in predicted severe acute pancreatitis.  Gut. 2001;  48 62-69
    CrossrefPubMedGoogle Scholar
  • 20 Mier J, Leon E L, Castillo A. et al . Early versus late necrosectomy in severe nocrotizing pancreatitis.  Am J Surg. 1997;  173 71-75
    CrossrefPubMedGoogle Scholar
  • 21 Nieuwenhuijs V B, Besselink M G, van Minnen L P. et al . Surgical management of acute necrotizing pancreatitis: a 13-year experience and a systematic review.  Scand J Gastroenterol Suppl. 2003;  239 111-116
    PubMedGoogle Scholar
  • 22 Risse O, Auguste T, Delannoy P. et al . Percutaneous video-assisted necrosectomy for infected pancreatic necrosis.  Gastroenterol Clin Biol. 2004;  28 868-871
    PubMedGoogle Scholar
  • 23 Sarr M G, Nagorney D M, Mucha Jr  P. et al . Acute necrotizing pancreatitis: management by planned, staged pancreatic necrosectomy/debridement and delayed primary wound closure over drains.  Br J Surg. 1991;  78 576-581
    CrossrefPubMedGoogle Scholar
  • 24 Seewald S, Groth S, Omar S. et al . Aggressive endoscopic therapy for pancreatic necrosis and pancreatic abscess: a new safe and effective treatment algorithm (videos).  Gastrintest Endosc. 2005;  62 92-100
    Google Scholar
  • 25 Szentkereszty Z, Kerekes L, Hallay J. et al . CT-guided percutaneous drainage in the treatment of acute necrotizing pancreatitis.  Magy Seb. 2001;  54 11-14
    PubMedGoogle Scholar
  • 26 Tsiotos G G, Luque-de Leon E, Soreide J A. et al . Management of necrotizing pancreatitis by repeated operative necrosectomy using a zipper technique.  Am J Surg. 1998;  175 91-98
    CrossrefPubMedGoogle Scholar
  • 27 Uhl W, Warshaw A, Imrie C. et al . IAP Guidelines for the surgical management of acute pancreatitis.  Pancreatology. 2002;  2 565-573
    CrossrefPubMedGoogle Scholar
  • 28 British Society of Gastroenterology . United Kingdom guidelines for the management of acute pancreatitis.  Gut. 1998;  42 (Suppl 2) 1-13
    PubMedGoogle Scholar
  • 29 Zhou Z G, Zheng Y C, Shu Y. et al . Laparoscopic management of severe aute pancreatitis.  Pancreas. 2003;  27 e46-e50
    PubMedGoogle Scholar
  • 30 Zhu J, Fan X, Zhang X. Laparoscopic treatment of severe acute pancreatitis.  Surg Endosc. 2001;  15 146-148
    CrossrefPubMedGoogle Scholar

Priv. Doz. Dr. med. T. Keck

Abt. Allgemein- und Viszeralchirurgie mit Poliklinik Chirurgische Universitätsklinik Freiburg

Hugstetter Straße 55

79110 Freiburg i. Br.

Phone: 07 61/2 70 24 01

Fax: 07 61/2 70 28 04

Email: tobias.keck@uniklinik-freiburg.de