Objective: To assess the safety and efficacy of abdominal paracentesis drainage (APD) prior to percutaneous catheter drainage (PCD) in treatment of acute pancreatitis (AP), with the purpose of further optimizing the “step-up” approach for management of AP. Methods: The clinical data of 102 consecutive patients with moderately severe acute pancreatitis (MSAP) or severe acute pancreatitis (SAP) treated between June 2009 and June 2011 were retrospectively analyzed. All these patients underwent a “step-up approach”, beginning with conservative treatment, then PCD, and finally open necrosectomy if needed. Of the patients, 53 cases underwent APD prior to PCD (APD plus PCD group), and 49 cases received PCD alone (PCD alone group), and the relevant clinical parameters between the two groups of patients were compared. Results: The baseline data between the two groups were comparable. The fatality rate in APD plus PCD group was significantly lower than that in PCD alone group (3.8% vs. 8.2%, P<0.05); the incidence of infection had no statistical difference between the two groups (P>0.05), but the time to white blood cell recovery, incidence of sepsis as well as time for sepsis recovery, and hospitalization cost were reduced in APD plus PCD group versus PCD alone group (all P<0.05). In addition, comparison of the clinical data 2 d before PCD between the two groups showed that all the levels of inflammatory cytokines and all the scores yielded by different severity scoring systems in APD plus PCD group were lower than those in PCD alone group (all P<0.05). Conclusion: Using APD as a bridging treatment between conservative treatment and PCD for AP is safe and effective, without an increase of infections. APD can reduce the levels of inflammatory factors and incidence of sepsis through effectively evacuating the fluid collections, and thereby improve the prognosis of the patients.

Objective: To investigate the clinical efficacy of percutaneous catheter drainage (PCD) under the guidance of Color Doppler ultrasound in treatment of severe acute pancreatitis (SAP) with abdominal fluid collections. Methods: The clinical data of 131 SAP patients with confirmed fluid induced (type II) intra-abdominal hypertension during the course of SAP were collected. Of the patients, 65 cases underwent ultrasound-guided PCD (observational group), while the other 66 cases underwent conservative treatment (control group). The relevant clinical variables, efficacy indexes, and incidence of complications and mortality between the two groups were compared. Results: The pre-treatment data between the two groups were comparable. Observational group was superior to control group with regard to the time to disappearance of symptoms and signs, to blood amylase level recovery, and to diet resumption as well as the length of total hospital stay (all P<0.05). The urinary bladder pressure in both groups showed a decreased trend after treatment, but the decreasing speed in observational group was faster than that in control group (P<0.05). The incidence of complications was reduced and the effective rate of treatment was increased in observational group compared with control group (both P<0.05). There was no statistical difference in mortality between the two groups (P>0.05). Conclusion: Early PCD can reduce the abdominal pressure in SAP patients with abdominal fluid collections, decrease the incidence of complications and shorten the course of disease, but it has no significant effect on mortality.

Objective: To assess the clinical efficacy of laparoscopic transabdominal preperitoneal approach (TAPP) for recurrent inguinal hernia after Lichtenstein hernioplasty. Methods: The clinical data of 12 patients with recurrent inguinal hernia after Lichtenstein surgery undergoing laparoscopic TAPP procedure between May 2009 and March 2014 in Xiangya Hospital were retrospectively analyzed. Results: Laparoscopic surgery was successfully performed in the entire group of patients, without any open conversion. The mean operative time was (110±25) min, and seroma occurred in 2 patients, which was resolved by needle aspiration. All patients recovered and were discharged from hospital within postoperative 48 h, and no re-recurrence was noted so far. Conclusion: Laparoscopic TAPP procedure is a safe and effective method in management of recurrent inguinal hernia after Lichtenstein repair.

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