Minimally invasive approach versus open approach in the management of necrotizing acute pancreatitis: A systematic review and meta-analysis

Acute pancreatitis is one of the most common gastrointestinal diseases, with necrotizing pancreatitis affecting 10% to 15% of patients. Over recent years, the management of pancreatic necrosis has evolved significantly, with a growing shift towards minimally invasive approaches. The aim of this study was to evaluate the effectiveness of minimally invasive approach compared to open surgical ap proach in managing necrotizing acute pancreatitis. A systematic review and meta-analysis were conducted, including 22 studies. Both fixed-effect and random-effect modelswere applied to analyze nine outcomes evaluated. Homogeneity among studies was assessed using χ2 tests, I2 statistics, and p-values. The risk of postoperative mortality, intra-abdominal bleeding, pancreatic and enteric fistulas, perforation, new-onset diabetes, and postoperative sepsis was significantly lower in the minimally invasive approach group than in the open surgical approach group. A minimally invasive approach to necrotizing acute pancreatitis might be associated with a lower risk of complications compared to an open surgical approach. However, most of the included studies were observational studies. Addition al randomized trials are needed to further confirm these findings.