Retroperitoneal versus open intraperitoneal necrosectomy in step-up therapy for infected necrotizing pancreatitis: A meta-analysis.

Background: Step-up therapy is the recommended therapy for infected necrotizing pancreatitis (INP). However, the most appropriate secondary therapy for use after initial drainage has not been fully determined. This meta-analysis was designed to evaluate the efficacy and safety of retroperitoneal versus open intraperitoneal necrosectomy as part of a step-up strategy for INP.

Materials And Methods: Eight online databases were searched for randomized controlled trials (RCTs) and cohorts comparing retroperitoneal and open intraperitoneal step-up approaches for treating INP. The data was pooled with a random-effects model.

Results: A total of 21 controlled studies (one RCT and twenty cohorts) and 2177 patients were included in this study. Our meta-analysis showed that the retroperitoneal group had a lower postoperative complication rate [risk ratio (RR) = 0.575, 95% confidence interval (CI) = 0.459 to 0.719, P < 0.001], lower postoperative mortality (RR = 0.525, 95% CI = 0.430 to 0.642, P < 0.001), higher technical success rate (RR = 1.313, 95% CI = 1.017 to 1.694, P = 0.037), similar surgical reintervention rate (RR = 0.930, 95% CI = 0.783 to 1.106, P = 0.411), shorter operative time [standardized mean difference (SMD) = -2.402, 95% CI = -3.642 to -1.161, P < 0.001], and shorter hospital stay (SMD = -2.034, 95% CI = -3.041 to -1.026, P < 0.001) than the open group. These results were supported by a subgroup analysis.

Conclusion: For treating INP, the retroperitoneal approach is safer and more effective than the open intraperitoneal approach.