Is necrosectomy obsolete for infected necrotizing pancreatitis? Is a paradigm shift needed?

In 1886,Senn stated that removing necrotic pancreatic and peripancreatic tissue would benefit patients with severe acute pancreatitis.Since then,necrosectomy has been a mainstay of surgical procedures for infected necrotizing pancreatitis(NP).No published report has successfully questioned the role of necrosectomy.Recently,however,increasing evidence shows good outcomes when treating walled-off necrotizing pancreatitis without a necrosectomy.The literature concerning NP published primarily after 2000 was reviewed;it demonstrates the feasibility of a paradigm shift.The majority(75%)of minimally invasive necrosectomies show higher completion rates:between 80%and 100%.Transluminal endoscopic necrosectomy has shown remarkable results when combined with percutaneous drainage or a metallic stent.Related morbidities range from 40%to 92%.Single-digit mortality rates have been achieved with transluminal endoscopic necrosectomy,but not with video-assisted retroperitoneal necrosectomy series.Drainage procedures without necrosectomy have evolved from percutaneous drainage to transluminal endoscopic drainage with or without percutaneous endoscopic gastrostomy access for laparoscopic instruments.Most series have reached higher success rates of 79%-93%,and even 100%,using transcystic multiple drainage methods.It is becoming evident that transluminal endoscopic drainage treatment of walledoff NP without a necrosectomy is feasible.With further refinement of the drainage procedures,a paradigm shift from necrosectomy to drainage is inevitable.

Impact of Semen Liquefaction and Viscosity on the Outcomes of in vitro Fertilization

Objective To compare the outcomes of in vitro fertilization （IVF） and intracytoplasmic sperm injection （ICSI） between semen liquefaction and viscosity with normal and abnormal. Methods Semen that liquefied within 60 min and normal viscosity was assigned to the normal group, while semen that unliquefied more than 60 min or high viscosity was assigned to abnormal group. Equal volumes of culture medium were added to abnormal group and normal control group, followed by repeated pipetting, to induce liquefaction. Sperm parameters, fertilization and cleavage rates, good-quality embryo rate, im- plantation rate and pregnancy rate were analyzed. Results The abnormal group ratio was much higher in the ICSI group （30.5%） than in the IVF group （21.9%） （P〈0.05）. The age of the husbands and total progressive motility （PR） sperm in abnormal IVF group were higher than those in normal IVF group （P〈0.05）. Fertilization rate （80.7%） in the abnormal IVF group was higher than that in the normal IVF group （75.6%） and normal control group （P〈0.05）. There were no differences in outcomes of the ICSI patients between the normal and abnormal groups. There was no difference between normal group and normal control group. Conclusion Equal volume of culture media was added to non-liquefied semen may be used to high viscosity and unliquefied semen, and may have a positive effect on fertilization outcomes.