Discussion
PCD, necrotic, necrosis
NECROSIS, DISEASE, NECROTIC, COMPLICATION, MEDICAL COMPLICATION, NECROTIC DEBRIS
Currently, a step-up approach applying PCD and other minimal-access interventions has been proven to have more favorable outcomes for the management of WON [Although several therapeutic schemes have emerged and significant progress towards reducing mortality and the risk of medical complications has been made in the treatment for NP during the last decade, it is clear that sufficient drainage and/or debridement remain the most important component in the management of WON, a delayed but life-threatening NP complication [The VARTD technique allows for good efficacy while evacuating the necrotic collections that located both centrally and diffusely throughout the abdomen. The continuous postoperative lavage also provides advantage in constant evacuations of necrotic debris, inflammatory exudate, vasoactive and toxic products, active enzymes, and bacteria and the toxins thereof [Results reported here also indicate an acceptable safety profile of the VARTD approach. The rates of postoperative complication-morbidity and mortality of the VARTD were substantially lower when compared with those of open surgical debridement as previously reported [Percutaneous catheter drainage or endoscopically transluminal drainage for necrotic collection is preferably postponed, usually > 4 weeks after the disease onset, waiting until necrosis has been encapsulated [This was a proof-of-concept study and has some limitations. The small sample size and lack of the risk factor-matched control groups do not allow us to make conclusions about the real safety of the VARTD. Such may also lead to an overestimation of effectiveness of this technique in the face of improving patient outcomes, thus its efficacy should be interpreted in mind. Furthermore, a potential discrepancy between the participants initially treated at primary hospitals and at tertiary referral centers regarding patterns of clinical management prior to receiving the VARTD was not resolved, advertising the potential for an indispensable selection bias. In addition, there remain limited knowledge regarding infected WON with deep extension, and there is no consensus on standard definition for its clinical improvement, thus our a priori definition may result in design bias. This may lead to a reduction in the reintervention rate after the VARTD as compared with other minimal-access techniques as reported previously.