ArticleFrontiers in surgery2026
Surgery for necrotizing acute pancreatitis: surgical approach, morbidity and challenges encountered: experience from a tertiary care hepatopancreatobiliary unit in Sri Lanka.
Article in Frontiers in surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
Background: Infected pancreatic necrosis (IPN) remains a life-threatening complication of acute pancreatitis. While minimally invasive "step-up" strategies are now standard, their implementation in resource-limited settings is often constrained by availability of interventional radiology, advanced endoscopy, and intensive care support. This study describes management pathways, morbidity, and outcomes of surgically treated IPN in a tertiary hepatopancreatobiliary (HPB) unit operating under such limitations. Methods: A retrospective analysis of prospectively maintained data was performed on patients who underwent surgical necrosectomy for IPN between 2015 and 2021. Management followed a step-up philosophy where feasible, incorporating antibiotics, image-guided or endoscopic drainage, and delayed surgery. Clinical characteristics, interventions, complications, and outcomes were analysed descriptively. Results: Six patients underwent surgery for IPN. Initial interventions included ultrasound-guided percutaneous drainage ( Conclusion: In resource-limited environments, the step-up approach to IPN is frequently constrained by service availability rather than intent. Open necrosectomy remains an essential salvage strategy when minimally invasive interventions are unavailable or unsuccessful, but is associated with significant morbidity. Careful patient selection, delayed intervention, and multidisciplinary management are critical to achieving acceptable outcomes.
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