Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Surgery Today
Published in: Surgery Today 3/2016

01-03-2016 | Original Article

Early-phase peritoneal drainage and lavage in a rat model of severe acute pancreatitis

Authors: Leiming Zhu, Jilin Lu, Jing Yang, Peng Sun

Published in: Surgery Today | Issue 3/2016

Login to get access

Abstract

Purpose

To evaluate the effects of early-phase drainage on the survival rates and pancreatic pathological changes associated with severe acute pancreatitis (SAP) in a rat model.

Methods

Sprague–Dawley rats were divided into the following groups: SAP model (control), early drainage and delayed drainage. The 24-h survival rates were compared among the groups. In addition, the serum and ascites concentrations of interleukin (IL)-1β, IL-6, IL-8, IL-10 and tumor necrosis factor (TNF)-α were measured, and pancreatic pathological changes were observed.

Results

The survival rate significantly improved in the early drainage group. Compared with that observed in the control group, the serum TNF-α and IL-8 concentrations in the early drainage group decreased, while the serum IL-10 levels increased, and the ascites concentrations of IL-1β, IL-6, IL-8 and TNF-α decreased, while that of IL-10 increased significantly. In the delayed drainage group, only the ascites concentrations of TNF-α decreased. Meanwhile, the pancreatic pathological changes at 3, 6 and 24 h worsened in the early drainage group; however, the pancreatic lesions in the early drainage group were less mild than those seen in the control group.

Conclusions

Rebalancing the cytokine levels in ascites after early drainage may be a key factor for enhancing the survival rate in rats.
Literature
1.
Mole DJ, Olabi B, Robingson V, Garden OJ, Parks RW. Incidence of individual organ dysfunction in fatal acute pancreatitis: analysis of 1024 death records. HBP. 2009;11:166–70.
2.
Fu CY, Yeh CN, Hsu JT, Jan YY, Hwang TL. Timing of mortality in severe acute pancreatitis: experience from 643 patients. World J Gastroenterol. 2007;13:1966–9.PubMedCentralCrossRefPubMed
3.
Sun JK, Li WQ, Ni HB, Ke L, Tong ZH, Li N, et al. Modified gastrointestinal failure score for patients with severe acute pancreatitis. Surg Today. 2013;43:506–13.CrossRefPubMed
4.
Uhl W, Warshaw A, Imrie C, Bassi C, McKay CJ, Lankisch PG, et al. IAP guidelines for the surgical management of acute pancreatitis. Pancreatology. 2002;2:565–73.CrossRefPubMed
5.
Hasibeder WR, Torgersen C, Rieger M, Dünser M. Critical care of the patient with acute pancreatitis. Anaesth Intensive Care. 2009;37:190–206.PubMed
6.
Andersson R, Sward A, Tingstedt B, Akerberg D. Treatment of acute pancreatitis: focus on medical care. Drugs. 2009;69:505–14.CrossRefPubMed
7.
Bakker OJ, Van Santuoort HC, Basselink MGH, Uan der Harst E, Hofker HS, Goozen HG, Dutch Pancreatitis Study Group. Prevention, detection and management of infected necrosis in severe acute pancreatitis. Curr Gastroenterol Rep. 2009;11:104–10.CrossRefPubMed
8.
Nieuwenhuijs VB, Besselink MG, van Minnen LP, Gooszen HG. Surgical management of acute necrotizing pancreatitis: a 13-year experience and a systematic review. Scand J Gastroenterol Suppl. 2003;239:111–6.CrossRefPubMed
9.
Rau B, Bothe A, Beger HG. Surgical treatment of necrotizing pancreatitis by necrosectomy and closed lavage: changing patient characteristics and outcome in a 19-year, single-center series. Surgery. 2005;138:28–39.CrossRefPubMed
10.
De Waele JJ, Hoste E, Blot SI, Hesse U, Pattyn P, de Hemptinne B, et al. Perioperative factors determine outcome after surgery for severe acute pancreatitis. Crit Care. 2004;8:R 504–11.CrossRef
11.
Cheung MT, Li WH, Kwok PC, Hong JK. Surgical management of pancreatic necrosis: towards lesser and later. J Hepatobiliary Pancreat Sci. 2010;17:338–44.CrossRefPubMed
12.
Fotoohi M, Traverso LW. Management of severe pancreatic necrosis. Curr Treat Options Gastroenterol. 2007;10:341–6.CrossRefPubMed
13.
Bruennler T, Hamer OW, Lang S, Gruene S, Wrede CE, Zorger N, et al. Outcome in a large unselected series of patients with acute pancreatitis. Hepatogastroenterology. 2009;56:871–6.PubMed
14.
Runzi M, Niebel W, Goebell H, Gerken G, Layer P. Severe acute pancreatitis: nonsurgical treatment of infected necroses. Pancreas. 2005;30:195–9.CrossRefPubMed
15.
Navalho M, Pires F, Duarte A, Goncalves A, Alexandrino P, Tavora I. Percutaneous drainage of infected pancreatic fluid collections in critically ill patients: correlation with C-reactive protein values. Clin Imaging. 2006;30:114–9.CrossRefPubMed
16.
Ai X, Qian X, Pan W, Xu J, Hu W, Terai T, et al. Ultrasound-guided percutaneous drainage may decrease the mortality of severe acute pancreatitis. J Gastroenterol. 2010;45:77–85.CrossRefPubMed
17.
Mortelé KJ, Girshman J, Szejnfeld D, Ashley SW, Erturk SM, Banks PA, et al. CT-guided percutaneous catheter drainage of acute necrotizing pancreatitis: clinical experience and observations in patients with sterile and infected necrosis. AJR AM J Roentgenol. 2009;192:110–6.CrossRefPubMed
18.
Wig JD, Gupta V, Kochhar R, Doley RP, Yadav TD, Poornachandra KS, et al. The role of non-operative strategies in the management of severe acute pancreatitis. JOP J Pancreas. 2010;11:553–9.
19.
Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(1400–15):1416.
20.
Dugernier T, Laterre PF, Reynaert MS. Ascites fluid in severe acute pancreatitis: from pathophysiology to therapy. Acta Gastroenterol Belg. 2000;63:264–8.PubMed
21.
Walser EM, Nealon WH, Marroquin S, Raza S, Hernandez JA, Vasek J. Sterile fluid collections in acute pancreatitis: catheter drainage versus simple aspiration. Cardiovasc Interv Radiol. 2006;29:102–7.CrossRef
22.
Segal D, Mortelé KJ, Banks PA, Silverman SG. Acute necrotizing pancreatitis: role of CT-guided percutaneous catheter drainage. Abdom Imaging. 2007;32:351–61.CrossRefPubMed
23.
Kusske AM, Rongione AJ, Ashley SW, Mcfadden DW, Reber HA. Interleukin-10 prevents death in lethal necrotizing pancreatitis in mice. Surgery. 1996;120:284–9.CrossRefPubMed
24.
Babu RY, Gupta R, Kang M, Bhasin DK, Rana SS, Singh R. Predictors of surgery in patients with severe acute pancreatitis managed by the step-up approach. Ann Surg. 2013;257:737–50.CrossRefPubMed
25.
Freeny PC, Hauptmann E, Althaus SJ, Traverso LW, Sinanan M. Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. Am J Roentgenol. 1998;170:969–75.CrossRef
26.
Tang LJ, Wang T, Cui JF, Zhang BY, Li S, Li DX, et al. Percutaneous catheter drainage in combination with choledochoscope-guided debridement in treatment of peripancreatic infection. World J Gastroenterol. 2010;16:513–7.PubMedCentralCrossRefPubMed
27.
Horvath K, Freeny P, Escallon J, Heagerty P, Comstock B, Glickerman DJ, et al. Safety and efficacy of video-assisted retroperitoneal debridement for infected pancreatic collections: a multicenter, prospective, single-arm phase 2 study. Arch Surg. 2010;145:817–25.CrossRefPubMed
28.
Van Santvoort HC, Bakker OJ, Bollen TL, Besselink MG, Ahmed Ali U, Schrijver AM, Dutch Pancreatitis Study Group, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology. 2011;141:1254–63.CrossRefPubMed
29.
Van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, Dutch Pancreatitis Study Group, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010;362:1491–502.CrossRefPubMed
30.
Matsumoto K, Miyake Y, Nakatsu M, Toyokawa T, Ando M, Hirohata M, et al. Usefulness of early-phase peritoneal lavage for treating severe acute pancreatitis. Intern Med. 2014;53:1–6.CrossRefPubMed
31.
Zhang XP, Zhang J, Ma ML, Cai Y, Xu RJ, Xie Q, et al. Pathological changes at early stage of multiple organ injury in a rat model of severe acute pancreatitis. Hepatobiliary Pancreat Dis Int. 2010;9:83–7.PubMed
32.
Rau B, Bothe A, Kron M, Beger HG. Role of early multisystem organ failure as major risk factor for pancreatic infections and death in severe acute pancreatitis. Clin Gastroenterol Hepatol. 2006;4:1053–61.CrossRefPubMed
33.
Andersson R, Andersson B, Andersson E, Axelsson J, Eckerwall G, Tingstedt B. Acute pancreatitis-from cellular signaling to complicated clinical course. HBP. 2007;9:414–20.
34.
Granger J, Remick D. Acute pancreatitis: models, markers and mediators. Shock. 2005;24(Suppl 1):45–51.CrossRefPubMed
35.
36.
Norman JG, Fink GW, Denham W, Yang J, Carter G, Sexton C, et al. Tissue-specific cytokine production during experimental acute pancreatitis. A probable mechanism for distant organ dysfunction. Dig Dis Sci. 1997;42:1783–8.CrossRefPubMed
37.
Mayer J, Rau B, Gansauge F, Beger HG. Inflammatory mediators in human acute pancreatitis: clinical and pathophysiological implications. Gut. 2000;47:546–52.PubMedCentralCrossRefPubMed
38.
Stimac D, Fisić E, Milić S, Bilić-Zulle L, Perić R. Prognostic values of IL-6, IL-8, and IL-10 in acute pancreatitis. J Clin Gastroenterol. 2006;40:209–12.CrossRefPubMed
39.
Souza LJ, Coelho AM, Sampietre SN, Martins JO, Cunha JE, Machado MC. Anti-inflammatory effects of peritoneal lavage in acute pancreatitis. Pancreas. 2010;39:1180–4.CrossRefPubMed
40.
Sugimoto M, Takada T, Yasuda H, Nagashima I, Amano H, Yoshida M, et al. The lethal toxicity of pancreatic ascites fluid in severe acute necrotizing pancreatitis. Hepatogastroenterology. 2006;53:442–6.PubMed
41.
Lundberg AH, Eubanks JW 3rd, Henry J, Sabek O, Kotb M, Gaber L, et al. Trypsin stimulates production of cytokines from peritoneal macrophages in vitro and in vivo. Pancreas. 2000;21:41–51.CrossRefPubMed
42.
Solanki R, Thumma V, Sastry RA, Bheerappa N. The role of image guided percutaneous drainage in multidisciplinary management of necrotizing pancreatitis. Trop Gastroenterol. 2013;34:25–30.CrossRefPubMed
43.
Xu W, Roos A, Schlagwein N, Woltman AM, Daha MR, van Kooten C. Il-10-producing macrophages preferentially clear early apoptotic cells. Blood. 2006;107:4930–7.CrossRefPubMed
44.
Xu W, Schlagwein N, Roos A, van den Berg TK, Daha MR, van Kooten C. Human peritoneal macrophages show functional characteristics of M-CSF-driven anti-inflammatory type 2 macrophages. Eur J Immunol. 2007;37:1594–9.CrossRefPubMed
45.
Rongione AJ, Kusske AM, Reber HA, Ashley SW, McFadden DW. Interleukin-10 reduces circulating levels of serum cytokines in experimental pancreatitis. J Gastrointest Surg. 1997;1:159–66.CrossRefPubMed
46.
Fric P, Slabý J, Kasafírek E, Kocna P, Marek J. Effective peritoneal therapy of acute pancreatitis in the rat with glutaryl-trialanin-ethylamide: a novel inhibitor of pancreatic elastase. Gut. 1992;33:701–6.PubMedCentralCrossRefPubMed
Metadata
Title
Early-phase peritoneal drainage and lavage in a rat model of severe acute pancreatitis
Authors
Leiming Zhu
Jilin Lu
Jing Yang
Peng Sun
Publication date
01-03-2016
Publisher
Springer Japan
Published in
Surgery Today / Issue 3/2016
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-015-1172-9

Other articles of this Issue 3/2016

Surgery Today 3/2016 Go to the issue

Review Article

Proteomic analysis in cardiovascular research

Review Article

Current status of and perspectives regarding neoadjuvant chemoradiotherapy for locally advanced esophageal squamous cell carcinoma

Original Article

Importance of the intraoperative appearance of preserved parathyroid glands after total thyroidectomy

Original Article

Gasless transumbilical laparoscopic-assisted appendectomy as a safe and cost-effective alternative surgical procedure for mild acute appendicitis

Original Article

Laparoscopic Roux-en-Y gastric bypass in obese Korean patients: efficacy and potential adverse events

Review Article

Potential mechanisms mediating improved glycemic control after bariatric/metabolic surgery