Minimally invasive management of infected pancreatic necrosis: step-up approach at a reference center

Abstract

Introduction. Acute Pancreatitis is a common gastrointestinal pathology; whose infected necrotizing form carries a high Mortality rate (40-70%). Currently, management favors the minimally invasive approach (step-up approach). This study analyzes the experience of the Hospital Central del Instituto de Prevision Social with percutaneous Drainage in patients with Infected Pancreatic Necrosis. Objective. To analyze the experience in the management of infected pancreatic necrosis with percutaneous drainage at the Surgery Service of the Hospital Central del Instituto de Prevision Social, during the period from January 2021 to November 2023. Materials and Methods. A descriptive, retrospective, cross-sectional observational study was conducted, including 17 adult patients (consecutive cases) with infected pancreatic necrosis treated with percutaneous drainage as the first invasive measure during the 2021-2023 period. Variables analyzed included demographic data, time until drainage, number of catheters, and remission percentage. Results. Of the 17 patients, 11 achieved complete remission (clinical and imaging) with percutaneous drainage and antibiotic therapy. The mean time to drainage was 29.5 days. Six patients required additional procedures, with open necrosectomy being the most frequent (five patients). Final lethality was observed in two patients, both belonging to the group that required open surgery. Conclusion. Management with percutaneous drainage and antibiotic therapy was the definitive treatment in 11 cases, confirming that this minimally invasive approach is an effective strategy for infection control and reduction of mortality in severe acute pancreatitis due to infected pancreatic necrosis.