The Potential of Minimally Invasive Techniques in a Tailored Diagnostic and Therapeutic Strategy for Acute Necrotizing Pancreatitis

Introduction. Acute necrotizing pancreatitis (ANP), a severe acute pancreatitis accompanied by necrosis, is associated with high morbidity and mortality. Traditional management has shifted toward minimally invasive multimodal strate‑ gies, though a choice of optimal drainage procedures is still being debated and requires evidence-based guideliness. Aim: To analyze ANP outcomes and develop an effective minimally invasive drainage algorithm to reduce complications, mortality, and length of hospitalization. Materials and methods. A prospective study (2019–2024) included 136 ANP patients managed according to necrosis score versus 140 historical controls. Necrosis extent was defined using Revised Atlanta Cclassification: mild (≤30%), moderate (30–60%), extensive (>60%). Interventions included ultrasound-guided drainage, laparoscopic necrosectomy, and early open debridement. Conservative treatment comprised antibiotics, pro‑ longed epidural analgesia, enteral feeding. Outcomes were assessed using SAPS, APACHE II/III, MODS, and SOFA scores. Statistical analysis compared frequency of complications, mortality and length of hospitalization. Results. Protocol cohort showed significant improvements: Mild necrosis: Infections ↓ to 11.1% (vs. 23.6%; *p* = 0.01), mortality ↓ to 1.1% (vs. 5.2%; *p* = 0.03). Modertae necrosis: Laparoscopic necrosectomy reduced sepsis to 37.7% (Δ = 41.1%; *p* < 0.001), mortality ↓ to 11.4% (vs. 28.3%; *p* = 0.002). Extensive necrosis: Early open debridement ↓ endotoxico‑ sis mortality to 13.7% (vs. 41.2%; *p* = 0.007), overall mortality ↓ to 34.4% (vs. 62.1%; *p* = 0.01). Overall, protocol adherence ↓ infections by 65% (21.7% vs. 62.8%; *p* < 0.001), mortality by 24% (12.4% vs. 16.4%; *p* = 0.03), and lengths of hospital stays by 22% (58 vs. 74 days; *p* = 0.002). Discussion. This study validates a necrosis score protocol as superior to historical approaches. Minimally invasive techniques are definitive for mild/moderate necrosis, while early open debridement is critical for extensive necrosis. Key innovations (epidural analgesia, early enteral nutrition, step-up drainage) synergistically reduced systemic inflammation and sepsis. The 65% infection reduction underscores protocol efficacy, though multicenter validation is warranted. Conclusion. A tailored approach significantly improves ANP out‑ comes, offering a resource-efficient template for management.

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