I.N. Akhmetov1, Rim.A. Gilfanova1, 3, Reed.A. Gilfanova1, 3, R.A. Zefirov1, 2, S.I. Spiridonov1
¹Republican Clinical Hospital, Kazan
²Kazan State Medical University, Kazan
3Kazan State Medical Academy — Branch Campus of the FSBEI FPE RMACPE MOH Russia, Kazan
Akhmetov Irek Nasikhovich — head of department of X-ray surgical methods of diagnosis and treatment 2, doctor for X-ray endoscopic diagnosis and treatment
SAHI «Republican Clinical Hospital» of the Ministry of Health,
420064, Kazan, Orenburg Tract str., b.n. 138, tel.: + 7-917-873 79 43, e-mail: irek456@yandex.ru
SPIN Code: 2352-6248, ORCID ID: 0000-0002-5771-9572
Abstracts. The incidence of acute pancreatitis (AP) varies in different countries and regions of the world and has shown an increasing trend in recent decades. This is due to a number of factors, including changes in lifestyle, diet, and improved diagnosis and case reporting.
Successful treatment in cases of infected pancreonecrosis (IP) depends on timely surgical intervention. Approaches to the management of acute pancreatitis have changed with the introduction of the step-up strategy, indicating a shift towards minimally invasive techniques.
The advantages of the modified step-up approach in IPN are to improve treatment outcomes and reduce the risks associated with this severe pathology. The key aspects that make this approach effective are: the use of minimally invasive techniques in the initial stages of treatment. This may include puncture and endoscopic techniques that reduce inflammation and infection with less trauma to the patient’s body. The approach involves systematic planning (treatment staging) and performing several stages of interventions, starting with the least invasive. This allows treatment tactics to be adapted depending on the patient’s response and the dynamics of the disease, providing flexibility in the choice of the next stage. By gradually increasing the invasiveness of procedures and initially focusing on minimally invasive techniques, overall surgical trauma is significantly reduced.
This is particularly important in critically ill patients for whom classic extensive surgery may be too risky. The modified approach allows a more effective management of infection, preventing its spread and improving the removal of necrotized tissue. This helps to reduce the overall bacterial load and helps the body to recover faster. Staged treatment, through gradual removal of damaged tissue and control of infection, is associated with improved patient survival rates. This approach allows time for the patient to stabilize and avoids unnecessary complications. The flexibility of this approach allows the treatment plan to be tailored to the specific needs and condition of the patient, taking into account the individualized course of the disease.
These aspects make the modified staged approach more preferable in the treatment of UTIs, allowing for improved quality of care and a better chance of successful recovery.
Our aim is to determine the efficacy and safety of video-assisted retroperitoneoscopic assisted retroperitoneal debridemen (VARD) in the treatment of infected pancreonecrosis.
Key words: Acute necrotizing pancreatitis, infected pancreonecrosis, video-assisted retroperitoneoscopic sequestrectomy, step-by-step approach, step-up.