The Burden of Acute severe pancreatitis and early experience of Step-up approach for acute necrotizing pancreatitis at Military Hospital

  • Sushil Bahadur Rawal Nepalese Army Institute of Health Sciences
  • Uttam Laudari Kathmandu medical college
  • Basanta Khatiwada Nepalese Army Institute of Health Sciences
  • Anup Thapa Nepalese Army Institute of Health Sciences
  • Manoj Kumar Jha Nepalese Army Institute of Health Sciences
  • Jyoti Rayamajhi Nepalese Army Institute of Health Sciences
  • Srijan Malla Nepalese Army Institute of Health Sciences

Abstract

Introduction
Twenty-five percent of acute pancreatitis develops severe acute pancreatitis (SAP). SAP patients have prolonged hospitalization and require a substantial amount of manpower and hospital resources. The aim of this study was to give an insight into the burden of acute pancreatitis at a tertiary level military hospital and to share the experience of managing pancreatic necrosis with the application of the step-up approach.
 Methods
A prospective descriptive study of consecutive patients was conducted at Shree Birendra Army Hospital from 2017 June to 2017 November. Patients with a diagnosis of acute pancreatitis admitted were stratified according to severity as per Revised Atlanta classification 2012. Patients with acute necrotizing pancreatitis were enrolled for the step-up approach. Patient’s demography, baseline investigations, radiology, prognostic scoring scales and type of intervention were analyzed. The burden of severe acute pancreatitis at our center and the early experience of the step-up approach at our centre within the study period were studied.
Results
Out of 35 five patients with acute pancreatitis, 7 (20%) subsequently developed severe acute pancreatitis. Among them, five patients subsequently developed necrotizing pancreatitis who were managed according to the step-up approach. Out of them,  three patients subsequently underwent operative intervention in the form of minimally invasive procedures like percutaneous drain placement, laparoscopic necrosectomy, video-assisted retroperitoneal debridement, and open necrosectomy.
 Conclusion
Acute pancreatitis is a common presentation at our centre. The step-up approach in the management of acute necrotizing pancreatitis is a safe and feasible approach.

Author Biography

Sushil Bahadur Rawal, Nepalese Army Institute of Health Sciences
Associate Professor, Department of Surgery, Nepalese Army Institute of Health Sciences, Kathmandu, Nepal

References

1. Fisher WE, Andersen DK, Windsor JA, Saluja AK, Brunicardi FC. Pancreas. In: Brunicardi FC, Andersen DK, Billiar TR, Dunn DN, Hunter JG, Matthews JB, et al., editors. Schwartz’s principles of surgery. 10th ed. New Delhi: McGraw-Hill Education; 2014. p. 1341–422.
2. Shrestha PS, Acharya SP, Shrestha GS, Aryal D, Udaya RK, Marhatta MN. An audit of hepatobiliary diseases in a tertiary level intensive care unit in Nepal. Journal of Society of Anesthesiologists of Nepal. 2017 Jun 28;4(1):42-5.
3. van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA et al Dutch Pancreatitis Study Group. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010 Apr 22;362(16):1491-502..
4. Besselink MG1, van Santvoort HC, Nieuwenhuijs VB, Boermeester MA, Bollen TL, Buskens E et al Dutch Acute Pancreatitis Study Group. Minimally invasive 'step-up approach' versus maximal necrosectomy in patients with acute necrotising pancreatitis (PANTER trial): design and rationale of a randomised controlled multicenter trial [ISRCTN13975 68]. BMC Surg. 2006 Apr 11;6:6
5. Poudyal S, Singh YP. Early warning score in predicting the severity of acute pancreatitis. Journal of Society of Surgeons of Nepal.;17(1):16-20.
6. Bohara TP, Karki D, Parajuli A, Rupakheti S, Joshi MR. Haemoconcentration as a predictor of severity in acute pancreatitis. Journal of Kathmandu Medical College. 2015;4(1):3-7.
7. Besselink M, van Santvoort H, Freeman M, Gardner T, Mayerle J, Vege SS et al. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13(4, suppl 2):E1-5.
8. Li A, Cao F, Li J, Fang Y, Wang X, Liu DG et al. Step-up mini-invasive surgery for infected pancreatic necrosis: Results from prospective cohort study. Pancreatology. 2016 Jul 1;16(4):508-14.
9. Zerem E1, Imamovi? G, Suši? A, Hara?i? B. Step-up approach to infected necrotising pancreatitis: a 20-year experience of percutaneous drainage in a single centre. Dig Liver Dis. 2011 Jun;43(6):478-83.
10. Da Costa DW, Boerma D, Van Santvoort HC, Horvath KD, Werner J, Carter CR et al. Staged multidisciplinary step?up management for necrotizing pancreatitis. Br J Surg. 2014 Jan;101(1):e65-79.
11. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013 Jan 1;62(1):102-11.
12. Bohara TP, Laudari U, Parajuli A, Rupakheti S, Joshi MR. Prospective Validation of a Decision Tree Model for Prediction of Severity in Acute Pancreatitis. J Nepal Health Res Counc. 2018 Jul 4;16(2):239-244.
13. Manandhar S, Giri S, Poudel P, Bhandari RS, Lakhey PJ, Vaidya P. Acute biliary pancreatitis: an experience in a tertiary level hospital of Nepal. Indian J Surg. 2013 Dec;75(6):449-53.
14. Ranson JH. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974;139:69-81.
15. Papachristou GI, Muddana V, Yadav D, O’Connell M, Sanders MK, Slivka A et al. Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol. 2010 Feb;105(2):435-41.
16. Shin KY, Lee WS, Chung DW, Heo J, Jung MK, Tak WY et al. Influence of obesity on the severity and clinical outcome of acute pancreatitis. Gut Liver. 2011 Sep;5(3):335-9.
17. Gupta K, Wu B. In the Clinic Acute Pancreatitis. Ann Intern Med. 2010;153(9):ITC5-1.
18. Andersson B, Appelgren B, Sjödin V, Ansari D, Nilsson J, Persson U et al. Acute pancreatitis–costs for healthcare and loss of production. Scand J Gastroenterol. 2013 Dec;48(12):1459-65.
19. Murata A, Matsuda S, Mayumi T, Okamoto K, Kuwabara K, Ichimiya Y et al. Multivariate analysis of factors influencing medical costs of acute pancreatitis hospitalizations based on a national administrative database. Dig Liver Dis. 2012 Feb;44(2):143-8.
Published
2020-01-13
How to Cite
RAWAL, Sushil Bahadur et al. The Burden of Acute severe pancreatitis and early experience of Step-up approach for acute necrotizing pancreatitis at Military Hospital. J Soc Surg Nep, [S.l.], v. 22, n. 2, p. 11-17, jan. 2020. ISSN 2392-4772. Available at: <http://jssn.org.np/index.php?journal=jssn&page=article&op=view&path%5B%5D=316>. Date accessed: 04 apr. 2020.