Introduction : To delay the surgery, percutaneous or endoscopic drainage was usually performed as the first step in step-up approach for infected pancreatic necrosis(IPN). However, drainage was unnecessary or unavailable in some patients. To explore the safety and effect of upfront laparoscopic assisted necrosectomy in treatment of IPN.

Methods : IPN patients received surgical therapy in our center between January 2015 and December 2017 were included in this study. Patients were assigned to either single or step-up group according to the received therapeutic approach. Incidence of complications, death, total number of surgical intervention and total hospital stay were compared. Logistic regression and nomogram were used to explore the risk factors and probability for patients undergoing surgical intervention≥3 times.

Results : There were 45 and 49 patients included in single step and step-up group, respectively. No significant difference between groups in terms of new organ failure(14.29% vs. 14.33%, p=0.832), death(8.89% vs.8.17%, p=0.949) and long-term complications(18.37% vs. 15.56%, p=0.717). However, the number of surgical intervention in single step group was significant less than in step-up group with shorter hospital stay. After multivariate analysis, CRP, IL-6 and surgical approach were independent predicators for patients undergoing surgical intervention≥3. A nomogram was built with area under ROC curve 0.891.

Conclusions : Compared with step-up approach, single up surgery was safe and effective in selected IPN patients with less number of surgical intervention and shorter hospital stay.
v