Ulus Travma Acil Cerrahi Derg. 2018; 24(5): 488-496 | DOI: 10.5505/tjtes.2018.84589

Walled-off pankreatik nekrozda morbiditiye etki eden risk faktörleri ve sürekli postoperatif lavajýn etkinliði: Tek merkez deneyimi

Mehmet Aziret¹, Metin Ercan¹, Bilal Toka², Erkan Parlak², Kerem Karaman^1
1Sakarya Üniversitesi Eðitim Ve Araþtýrma Hastanesi Genel Cerrahi Kliniði, Sakarya Türkiye
²Sakarya Üniversitesi Eðitim Ve Araþtýrma Hastanesi Gastroenteroloji Kliniði, Sakarya Türkiye

Amaç: Walled-off pankreatik nekrozda (WOPN) morbiditeye eden risk faktörlerini deðerlendirmek ve endoskopik nekrozektomiye dirençli hastalarda sürekli postoperatif lavajýn etkilerini ortaya koymayý planladýk.
Materyal ve Metot: Bu çalýþmaya hastanemizde cerrahi tedavi veya endoskopik nekrozektomi yapýlan 28 WOPN’ lu hastanýn 19’u kabul edildi ve hastalar iki gruba ayrýldý; ilk akut pankreatit (AP) tanýsý konulduðu zaman (grup 1, n= 19), operasyon veya endoskopik nekrozektomi yapýlan zamana kadar (grup 2, n= 19). Hastalar demografik özellikleri, operasyon bulgularý ve komplikasyonlarý açýsýndan karþýlaþtýrýldý.
Sonuçlar: Hastalar hastanede kalýþ süresi ve komplikasyon arasýnda, yaþ, VKÝ (Vücut kitle indeksi), WOPN çapý, ASA skoru (American Society of Anesthesiologists), Ranson kriteri, operasyon zamaný, ilk baþvuradan operasyon veya endoskopik nekrozektomi yapýlan zamana kadar deðerlendirildiðinde istatistiksel farklýlýk yoktu (P>0.05). Endoskopik nekrozektomi yapýldýkça komplikasyon sayýsý azalmaktaydý (B=-0.626, 95% CI: -0.956 - -0.296 ve P<0.001), ayrýca ilk baþvurudaki nötrofil lenfosit oraný (NLR) düzeyi arttýkça komplikasyon sayýsý artmaktaydý (B=0.032, 95% CI: 0.009 - 0.055 ve P=0.01). Kültürde üreme (B=0.669, 95% CI: 0.365 - 0.973 ve P<0.001) ve erkek cinsiyet (B=0.484, 95% CI: 0.190 - 0.778 veP=0.003) hastanede kalýþ süresini arttýran risk faktörüydü.
Sonuç: Sürekli postoperatif lavaj WOPN’ da etkili ve güvenli bir cerrahi tedavi yöntemidir. Ayrýca, kültürde üreme, erkek cinsiyet, yüksek NLR düzeyi, yetersiz veya ulaþýlamayan endoskopik nekrozektomi kötü prognoza etki eden risk faktörleridir.

Anahtar Kelimeler: Nekrozektomi, sürekli postoperatif lavaj, walled-off pankreatik nekrozis (WOPN)

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Risk factors for morbidity in walled-off pancreatic necrosis and performance of the continuous postoperative lavage: a single center experience

Mehmet Aziret¹, Metin Ercan¹, Bilal Toka², Erkan Parlak², Kerem Karaman^1
1Sakarya University Education And Research Hospital Department Of General Surgery Sakarya, Turkey
²Sakarya University Education And Research Hospital Department Of Gastroenterology Sakarya, Turkey

BACKGROUND: The aim of this study was to evaluate the risk factors for morbidity in cases of walled-off pancreatic necrosis (WOPN) and the performance of continuous postoperative lavage (CPL) for patients who demonstrated resistance to a minimally invasive approach.
METHODS: The study enrolled 19 of 28 consecutive patients with WOPN who underwent surgical treatment or an endoscopic necrosectomy at Sakarya University Education and Research Hospital. The patients were divided into 2 groups according to the length of time from the first diagnosis of acute pancreatitis (AP) (Group 1, n=19) to preoperation or endoscopic necrosectomy (Group 2) (n=19). All of the cases were retrospectively evaluated and compared in terms of demographic features, operative features, and complications.
RESULTS: No statistically significant difference was found between the number of complications or the duration of hospital stay in terms of age, body mass index, size of the walled-off pancreatic necrosis, American Society of Anesthesiologists score, Ranson’s criteria, operation time, and duration from AP to endoscopic necrosectomy or operation (p>0.05). Performance of an endoscopic necrosectomy was determined to be correlated with a decrease in the number of complications (B=-0.626, 95% confidence interval [CI]: -0.956 to -0.296; p<0.001), and when a high neutrophil-to-lymphocyte ratio (NLR) was detected at first admission, the number of complications was greater (B=0.032, 95% CI: 0.009–0.055; p=0.01). Reproduction in a culture and male gender were found to be risk factors for a prolonged hospital stay (B=0.669, 95% CI: 0.365–0.973; p<0.001), (B=0.484, 95% CI: 0.190–0.778; p=0.003), respectively.
CONCLUSION: CPL is a safe and effective surgical treatment approach for WOPN. Reproduction in a culture, male gender, and a high NLR on first admission and a negative or not-available endoscopic necrosectomy were determined to be risk factors for a poor prognosis.

Keywords: Continuous postoperative lavage, necrosectomy, walled-off pancreatic necrosis (WOPN)

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