Claudio Navarrete, MD1, Cecilia Castillo, MD2, Eduardo Valdivieso, MD3, Oscar Barrera, MD3, Manuel Arrieta, MD4. 1Chief Department of Surgery Clínica Santa María and Latin American Gastrointestinal Endoscopy Training Center, Santiago, Chile., 2Digestive Disease Department, Clínica Alemana, Santiago, Chile, Latin American Gastrointestinal Endoscopy Training Center, 3Associate professor Latin American Gastrointestinal Endoscopy Training Center, 4University Of Sabana, Colombia
Introduction: The paradigm of open surgical management in patients with pancreatitis complicated by necrosis and infected collections has recently changed. The use of minimally invasive surgery (MIS) techniques has shown promising results and reduces the morbidity and mortality of traditional surgery. One of the different MIS approaches is the Percutaneous Assisted Transprosthetic endoscopic therapy (PATENT), a hybrid technique that combines the best of the endoscopic and retroperitoneal approaches.
Methods: Retrospective, descriptive study of patients who were admitted to our hospital with acute pancreatitis complicated by necrosis or infected collections between June 2010 and July 2017. In our series we performed a step-up approach management, where the necrotized pancreas or retroperitoneal infected collection was initially drained percutaneously through a CT-guided catheter. If the procedure failed, patients underwent the combined endoscopic and retroperitoneal debridement PATENT. In the procedure a biliary guidewire is inserted through the drainage catheter to reach the collection and then the catheter is removed. Later, the tract between abdominal wall and the collection is dilated and the distance is measured to choose the length of a prothesis to be inserted, in our series a fully covered self-expandable metal stent was used. Afterwards, the endoscope is advanced through the expanded stent toward the collection and debridement is performed. Finally, a collector system is left, allowing endoscopic re-exploration to be performed if necessary. We collected demographic and outcome data on patients who underwent the procedure including: gender, age, etiology of pancreatitis, collection size, number of interventions, complications and mortality.
Results: A total 19 patients underwent PATENT: eleven women (57.8%) and eight men (42.2%) with a median age of 34 years (Range: 24-46). The average size of the drained collections was 17cm and the success rate was 93.85%. 3 patients (15.7%) had complications and one patient died (5.26%). None of the complications needed open surgery and no cases of 30 – day – mortality after discharged were identified.
Conclusions: Our preliminary experience using PATENT for patients with complications of severe pancreatitis demonstrated the technique to be safe and reproducible, with an excellent success rate and low morbidity and mortality. We consider this technique to be an important option to be considered along different MIS methods for this catastrophic pathology.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94833
Program Number: P610
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster