Give 3 interventions that are available to manage pancreatic necrosis?

  • Aim of drainage is to remove infected material without breaching the peritoneum
  • Optimum method remains controversial – usually dependent upon local resources and expertise:
Percutaneous Drainage (1)

Transluminal Drainage (1)
    Surgical Necrosectomy (1)
  • Associated with fewer complications than surgical necrosectomy though no mortality benefit
  • Avoids surgical necrosectomy in30-50% of cases
  • Can be considered as a bridge to surgery in patients to unstable placement of a drainage tube into the fluid collection
    • Like percutaneous drainage associated with less morbidity and cost than surgical necrosectomy
    • Involves insertion of a stent to drain necrotic cavity into gastric or duodenal lumen
    • Used only in carefully selected patients and is dependent on local expertise.
      • Once the gold standard now less frequently used as first line
      • Debridement is done bluntly with hydrosonic irrigation frequently used to avoid vascular injury
      • May require multiple operations to achieve adequate debridement