Initial minimally invasive retroperitoneal necrosectomy for acute necrotizing pancreatitis

Abstract

Introduction:Minimally invasive approches in treatment of acute necrotizing pancreatitis and/or infected pancreatic necrosis gain a notable advantage compared with open surgery. Aim:We present our experience in treatment of acute necrotizing pancreatitis by an original minimally invasive retroperitoneal necrosectomy technique, evaluate feasibility and safety of this method, compare our results to other studies. Patients and methods:A retrospective analysis of 22 patients with acute necrotizing pancreatitis and large fluid collections in retroperitoneal space was performed. All patients underwent retroperitoneal necrosectomy as an initial interventional procedure in treatment of infected pancreatic necrosis. Results:Sixteen males and six females aged between 24 and 60 with an average age of 42.59 ±7.3 years were included. Alcohol abuse was an etiologic factor of acute necrotizing pancreatitis for 18 patients (81.8%). Average time between diagnosis and performance of necrosectomy was 28.6 ±13.2 days. Ten patients (45.5%) did not undergo any additional intervention after initial retroperitoneal necrosectomy. Other 12 patients (54.5%) required additional procedures. 3 Medical Research ArchivesCopyright 2015 KEI Journals. All rights reserved 2 patients (13.6%) needed 5 or more reinterventions: 4 sonoscopically-guided drainages, 4 retroperitoneal renecrosectomies and 11 laparotomies. 9 patients (40.9%) required less than 5 reinterventions: 2 sonoscopically-guided drainages, 12 retroperitoneal renecrosectomies and 3 laparotomies. Most of reinterventions were performed due to insufficient drainage and bleeding. 63.6% of our patients did not require more than one reintervention. Postoperative hospitalisation ranged from 9 to 148 days with an average of 52.2 ±35.2 days. The mortality rate in our study was 0%. Conclusions:Minimally invasive techniques should be considered as a first-choice surgical option in treating patients with acute necrotizing pancreatitis whenever possible. Pancreatic necrosis occupying less than 30% and with massive fluid collections can be safely managed by an initial minimally invasive retroperitoneoscopic necrosectomy when an appropriate gap in the left retroperitoneum between the colon and the kidney exist.

Combined minimally invasive management of infected pancreatic necrosis: a case report.

“…Retroperitoneoscopic minimal access necrosectomy allowed almost complete removal of the necrotic debris and controlled infection in this patient. Several techniques of minimally invasive pancreatic necrosectomy have been developed [ 3 , 5 – 8 ]. Percutaneous retroperitoneal pancreatic necrosectomy is best suited for patients with necrosis and fluid collections extending into the pararenal spaces, especially on the left side.…”

“…Nevertheless, surgical treatment results in high rates of morbidity (34% to 95%) and mortality (11% to 39%) [ 2 – 4 ]. Recently, several techniques of minimal access pancreatic necrosectomy have been reported [ 5 – 8 ]. Modern management of necrotizing pancreatitis involves usage of multiple minimally invasive techniques usually at different stages of the disease.…”

Transpapillary drainage of walled-off pancreatic necrosis - a single center experience.

“…During the last two decades there has been constant development of minimally invasive techniques of treatment of acute necrotizing pancreatitis consequences [ 6 – 11 ]. Minimal invasive methods of WOPN treatment enable transperitoneal, retroperitoneal, transmural or transpapillary access to the necrosis [ 7 , 8 ]. Moreover, such methods result in better outcomes as well as in higher safety in comparison to classical surgical treatment [ 12 , 13 ].…”

Transpapillary drainage of pancreatic parenchymal necrosis.

“…Procedures of open necrosectomy are associated with high morbidity and mortality [ 6 , 7 ]. In the past decades technological progress has led to development of minimally invasive techniques of walled-off pancreatic necrosis (WOPN) treatment [ 1 – 3 ]. These techniques include procedures performed with an endoscope, a laparoscope and a nephroscope, which enable a transperitoneal, retroperitoneal, transmural or transpapillary approach to necrosis [ 2 ].…”