Outcome of open necrosectomy versus minimally invasive retroperitoneal necrosectomy following percutaneous drainage in infected necrotising pancreatitis

Abstract

Introduction: To evaluate the role of minimally invasive surgery for management of necrotizing pancreatitis in the acute setting and to propose tailor made approaches to deal with various locations of pancreatic necrosis. Methods: A total of 112 patients (75 males, 37 females) with mean age of 41.5+10.3 years, with necrotizing pancreatitis underwent minimally invasive necrosectomy between January 2009 and May 2019. Laparoscopic necrosectomy was performed by transperitoneal approach in 81 patients , by retroperitoneoscopy in 18 patients and combined approach in 13 patients. Out of 81 patients treated by transperitoneal approach, 21 were approached through lesser sac, 48 through mesocolic route and 12 through paracolic route. In cases of retroperitoneoscopy, all cases were accessed through the left flank. Results: All patients tolerated the procedure well. Mean BMI was 26.45AE3.78 kg/sqm.Mean operating time was 56.40AE20.48 minutes and mean blood loss was 120AE31.45 ml.Eight patients required reoperation (6 underwent open procedure and 2 underwent laparoscopic redo necrosectomy). Six patients died of multi-organ failure. The mean duration of return of bowel function was 5AE1.8 days. The mean length of hospital stay after surgery was 8.19 AE4.09 days. There were no major wound related complications. Conclusion: Minimally invasive approach to pancreatic necrosectomy is safe and feasible with good outcomes in centres with adequate expertise . In addition to careful case selection, proper timing and optimal route of access determines the outcome. Minimally invasive procedures are suitable alternatives especially in critically ill patients providing lower morbidity and mortality rates.