OBJECTIVE To compare outcomes of laparoscopic transgastric necrosectomy (LTN) and direct endoscopic necrosectomy (DEN) in the management of retrogastric walled-off necrosis. SUMMARY OF BACKGROUND DATA Surgical and endoscopic transgastric approaches are used to manage retrogastric pancreatic necrosis. Studies comparing these treatment modalities are lacking but would influence contemporary practice patterns. METHODS LTN or DEN treated patients at Stanford University Hospital between 2011 and 2023 were identified. Cohort data included demographics, core pancreatitis care benchmarks, and clinical outcomes (total debridement time, new-onset endocrine and exocrine pancreatic insufficiency) as well as re-intervention, 30-day readmission, complication, and mortality rates. Long-term follow-up was also compared between intervention arms. Multivariable linear regression was used to assess the interaction between admission APACHE-II score and intervention on length of stay (LOS). RESULTS 106 patients (62% LTN, 38% DEN) were identified. Demographic and core pancreatitis benchmark data were similar between cohorts. 30-day readmission, complication, and mortality rates for surgical and endoscopic approaches were also similar: 23% vs. 25% (P = 0.98), 42% vs. 40% (P = 0.97), and 3% vs. 3% (P > 0.99). Median LTN total debridement time (minutes) was 131 vs. 134 for DEN, however, complete debridement was achieved with only 1 LTN compared to 3 DENs (P<0.01). While not statistically significant, LOS and unplanned intervention rates were less for LTN (8 vs. 10 days, P = 0.41 and 6% vs. 15%, P = 0.24). Multivariable analysis revealed a significant interaction between APACHE-II scores and LOS for LTN compared to DEN, which translated into a length of stay reduction for higher APACHE-II scoring patients (P = 0.02). CONCLUSIONS LTN is a safe and efficient treatment modality for walled-off necrosis, and compared to DEN, can reduce the LOS in high APACHE-II score patients. While additional comparative research between the two intervention types is needed, this study supports a role for a surgical approach in the management of retrogastric pancreatic necrosis.

中文翻译：

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这一切的背后是什么：胃后胰腺坏死治疗的回顾性队列研究。


目的 比较腹腔镜经胃坏死切除术（LTN）和直接内镜坏死切除术（DEN）治疗胃后壁坏死的效果。背景数据摘要手术和内窥镜经胃方法用于治疗胃后胰腺坏死。比较这些治疗方式的研究尚缺乏，但会影响当代的实践模式。方法 确定 2011 年至 2023 年间在斯坦福大学医院接受 LTN 或 DEN 治疗的患者。队列数据包括人口统计数据、核心胰腺炎护理基准和临床结果（总清创时间、新发内分泌和外分泌胰腺功能不全）以及再次干预、30 天再入院、并发症和死亡率。还对干预组之间的长期随访进行了比较。使用多变量线性回归评估入院 APACHE-II 评分与住院时间 (LOS) 干预之间的相互作用。结果 确定了 106 名患者（62% LTN，38% DEN）。队列之间的人口统计学和核心胰腺炎基准数据相似。手术和内窥镜方法的 30 天再入院率、并发症和死亡率也相似：23% vs. 25% (P = 0.98)、42% vs. 40% (P = 0.97) 和 3% vs. 3% （P> 0.99）。 LTN 总清创时间中位数（分钟）为 131 分钟，而 DEN 为 134 分钟，然而，与 3 个 DEN 相比，仅 1 个 LTN 即可实现完全清创 (P<0.01)。虽然没有统计学意义，但 LTN 的 LOS 和计划外干预率较低（8 天与 10 天，P = 0.41 和 6% vs. 15%，P = 0.24）。 多变量分析显示，与 DEN 相比，LTN 的 APACHE-II 评分与 LOS 之间存在显着交互作用，这意味着 APACHE-II 评分较高的患者的住院时间会缩短 (P = 0.02)。结论 LTN是一种安全有效的治疗围堵性坏死的方法，与DEN相比，可以减少高APACHE-II评分患者的LOS。虽然需要对两种干预类型进行额外的比较研究，但本研究支持手术方法在治疗胃后胰腺坏死中的作用。