Minimally invasive approach versus open approach in the management of necrotizing acute pancreatitis: A systematic review and meta-analysis

Abstract

Acute pancreatitis is one of the most common gastrointestinal diseases, with necrotizing pancreatitis affecting 10% to 15% of patients. Over recent years, the management of pancreatic necrosis has evolved significantly, with a growing shift towards minimally invasive approaches. The aim of this study was to evaluate the effectiveness of minimally invasive approach compared to open surgical approach in managing necrotizing acute pancreatitis. A systematic review and meta-analysis were conducted, including 22 studies. Both fixed-effect and random-effect models were applied to analyze nine outcomes evaluated. Homogeneity among studies was assessed using χ² tests, I² statistics, and p-values. The risk of postoperative mortality, intra-abdominal bleeding, pancreatic and enteric fistulas, perforation, new-onset diabetes, and postoperative sepsis was significantly lower in the minimally invasive approach group than in the open surgical approach group. A minimally invasive approach to necrotizing acute pancreatitis might be associated with a lower risk of complications compared to an open surgical approach. However, most of the included studies were observational studies. Additional randomized trials are needed to further confirm these findings.

Keywords: Acute pancreatitis; Minimally invasive approach; Necrosis pancreatic; Open approach.

Fig. 1

Flowchart showing the selection of studies.

Fig. 2

Procedures used in studies under review. DP, percutaneus drainage; VARD, video-assisted retroperitoneal debridement; OPEN, open surgery; MARPN, minimally invasive, and radiologically-guided pancreatic necrosectomy; MIN, minimally invasive necrosectomy; DETG, direct endoscopic transgastric drainage; NETG, necrosectomy via endoscopic transgastric approach.

Fig. 3

Risk of bias for included studies.

Fig. 4

Risk of bias for included studies.

Fig. 5

Meta-analysis of postoperative mortality after minimally invasive necrosectomy vs. open necrosectomy. CI, confidence interval; M-H, Mantel-Haenszel method.

Fig. 6

Meta-analysis of postoperative intra-abdominal bleeding after minimally invasive necrosectomy vs. open necrosectomy. CI, confidence interval; M-H, Mantel-Haenszel method.

Fig. 7

Meta-analysis of postoperative pancreatic fistula after minimally invasive necrosectomy vs. open necrosectomy. CI, confidence interval; M-H, Mantel-Haenszel method.

Fig. 8

Meta-analysis of postoperative enteric fistula after minimally invasive necrosectomy vs. open necrosectomy. CI, confidence interval; M-H, Mantel-Haenszel method.

Fig. 9

Meta-analysis of postoperative gastrointestinal perforation after minimally invasive necrosectomy vs. open necrosectomy. CI, confidence interval; M-H, Mantel-Haenszel method.

Fig. 10

Meta-analysis of postoperative pseudocyst after minimally invasive necrosectomy vs. open necrosectomy. CI, confidence interval; M-H, Mantel-Haenszel method.

Fig. 11

Meta-analysis of postoperative sepsis after minimally invasive necrosectomy vs. open necrosectomy. CI, confidence interval; M-H, Mantel-Haenszel method.

Fig. 12

Meta-analysis of postoperative new-onset diabetes after minimally invasive necrosectomy vs. open necrosectomy. CI, confidence interval; M-H, Mantel-Haenszel method.

Fig. 13

Meta-analysis of postoperative use of pancreatic enzyme after minimally invasive necrosectomy vs open necrosectomy. CI, confidence interval; M-H, Mantel-Haenszel method.