Laparoscopic necrosectomy in acute necrotizing pancreatitis: Our experience

Abstract

CONTEXT:Pancreatic necrosis is a local complication of acute pancreatitis. The development of secondary infection in pancreatic necrosis is associated with increased mortality. Pancreatic necrosectomy is the mainstay of invasive management.AIMS:Surgical approach has significantly changed in the last several years with the advent of enhanced imaging techniques and minimally invasive surgery. However, there have been only a few case series related to laparoscopic approach, reported in literature to date. Herein, we present our experience with laparoscopic management of pancreatic necrosis in 28 patients.MATERIALS AND METHODS:A retrospective study of 28 cases [20 men, 8 women] was carried out in our institution. The medical record of these patients including history, clinical examination, investigations, and operative notes were reviewed. The mean age was 47.8 years [range, 23-70 years]. Twenty-one patients were managed by transgastrocolic, four patients by transgastric, two patients by intra-cavitary, and one patient by transmesocolic approach.RESULTS:The mean operating time was 100.8 min [range, 60-120 min]. The duration of hospital stay after the procedure was 10-18 days. Two cases were converted to open (7.1%) because of extensive dense adhesions. Pancreatic fistula was the most common complication (n = 8; 28.6%) followed by recollection (n = 3; 10.7%) and wound infection (n = 3; 10.7%). One patient [3.6%] died in postoperative period.CONCLUSIONS:Laparoscopic pancreatic necrosectomy is a promising and safe approach with all the benefits of minimally invasive surgery and is found to have reduced incidence of major complications and mortality.

Surgical Management of Necrotizing Pancreatitis

“…Dissection is alternated with irrigation and suction to remove as much necrotic tissue as possible. [40] Once the necrosectomy is complete, large drainage catheters are placed in the cavity, which also allow for post-operative irrigation. At this time, consideration should also be given to cholecystectomy, if gallstones were implicated in the development of pancreatitis, and to nutritional access.…”

Pancreatic necrosis: Complications and changing trend of treatment

“…Lower complication rates were observed in a retrospective study evaluating the laparoscopic approach with open surgical approach favoring laparoscopic approach in terms of the occurrence of post-operative pancreatic fistula, blood loss, and average hospital length-of-stay (LOS) post-operatively[94]. Recently, a series by Mathew et al[95] showed that laparoscopic necrosectomy is a potentially safe and promising intervention having all the advantages of the minimally access approaches with a lower incidence of morbidity and mortality in contrast to the open surgical approaches.…”

Pathophysiological aspects as the object of the treatment tactics in acute pancreatitis (review)

“…Evaluation of endoscopic drainage results should be performed within the next 72 hours. Repeated endoscopic procedure should be performed in cases of no clinical improvement [2,3,5,6,28].…”

“…As for videolaparoscopy, it performs both diagnostic and therapeutic tasks. When perfor-ming videolaparoscopy, the diagnosis of acute pancreatitis should be confirmed and other acute abdominal diseases should be ruled out [23,25,28]. Significant signs of acute pancreatitis include edema of the mesenteric root of the colon, effusion with high amylase activity (2-3 times the activity of blood amylase), "vitreous edema" (serous infiltration of fatty tissue), the presence of foci of steatonecrosis (arising from the action of lipases and phospholipases).…”

“…Laparoscopic access to the pancreas is similar to that of open surgery: through the gastrocolic ligament or mesocolon. The ability to achieve the most complete removal of necrotic tissue makes the method particularly attractive [1,2,5,6,22,23,28,29].…”