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Commento all'ediorialie "Surgical management of pancreatic necrosis: A practice management guideline from the Eastern Association for the Surgery of Trauma."

 

 

 

 

 

Commento all’Editoriale a cura del Dott. Mario Baiamonte, in collaborazione con il dott. Salvatore Buscemi per la parte relativa alla ricerca bibliografica:

 

L’articolo si basa sulla revisione sistematica di 88 studi relativi al trattamento della necrosi da pancreatite acuta e pubblicati dal 1980 al 2014. Sono state valutate in particolare, tre questioni fondamentali:

 

1) Nei pazienti adulti con necrosi pancreatica, la chirurgia precoce rispetto alla chirurgia tardiva diminuisce i tassi di mortalità?

2) Nei pazienti adulti con necrosi pancreatica, l'intervento chirurgico riduce i tassi di mortalità rispetto al drenaggio percutaneo o al drenaggio endoscopico?

3) Nei pazienti adulti trattati per necrosi pancreatica, gli approcci mini-invasivi riducono il tasso di mortalità rispetto agli approcci open?

 

CONCLUSIONE:

• Nei pazienti adulti con necrosi pancreatica, si consiglia di differire la necrosectomia open di almeno 12 giorni dall’esordio clinico della pancreatite acuta.

• Durante i primi 30 giorni di sintomi con raccolte  necrotiche infetti, si consiglia condizionatamente il debridement chirurgico solo se i pazienti non riescono a migliorare dopo drenaggio radiologico e/o endoscopico.

• Infine, anche con necrosi infetta documentata, si consiglia di sottoporre i pazienti ad un approccio step-up all'intervento chirurgico.

 

 

 

Titolo Editoriale: Surgical management of pancreatic necrosis: A practice management guideline from the Eastern Association for the Surgery of Trauma.

Autori: Mowery NT1, Bruns BR, MacNew HG, Agarwal S, Enniss TM, Khan M, Guo WA, Cannon JW, Lissauer ME, Duane TM, Hildreth AN, Pappas PA, Gries LM, Kaiser M, Robinson BRH.

J Trauma Acute Care Surg. 2017 Aug;83(2):316-327. doi: 10.1097/TA.0000000000001510.

 

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