Minimally invasive strategy of infected pancreatic necrosis

Treatment of patients with pancreatic necrosis remains one of the most urgent and complex tasks in emergency surgery. The need for further research in this area is dictated by a high mortality rate (15–70 %). Active surgical approach at the first stage of severe pancreatitis is a necessary measure aimed at aspirating peritoneal exudate and reducing pressure in the abdominal cavity. At the second stage of the disease, infected pancreatic necrosis develops with purulentseptic complications and multiple organ failure. To date, the issue of surgical tactics in infected pancreatic necrosis, especially in relation to its walled-off forms, remains debatable. The problem of choosing an operative approach and strategy remains unresolved. In the article, we analyzed various options for minimally invasive surgery for treating patients with walled-off infected pancreatic necrosis. The timing of surgical treatment and methods of drainage and debridement (percutaneous drainage, endoscopic transluminal stent, video-assisted retroperitoneal necrosequestrectomy or VARD) were analyzed. The article also discusses a «step-up» minimally invasive strategy in terms of treatment effectiveness, complication rate and mortality. Most studies recommend adhering to a “step-up” strategy, which allows reducing the invasiveness of surgery, minimizing the risk of complications and shortening hospital stays. This approach is a promising direction in the treatment of patients with infected pancreatic necrosis.