Retroperitoneal drainage in the management of the septic phase of severe acute pancreatitis

Villazón, S A; Villazón, D Oscar; Terrazas, E. Francisco; Rana, Gurteshwar

doi:10.1007/bf01658976

Cited by 26 publications

(2 citation statements)

References 21 publications

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“…The overall mortality was 33%, but this was only 18% in the 22 patients in whom the retroperitoneal approach was the only abdominal procedure performed [27]. Similarly good results have been reported in three other small series [28, 29, 30]. Combining both the percutaneous and the retroperitoneal approaches a minimally invasive technique was developed by Carter et al [31]from Glasgow.…”

Section: Introductionmentioning

confidence: 98%

Minimally Invasive Retroperitoneal Pancreatic Necrosectomy

Connor¹,

Ghaneh²,

Raraty³

et al. 2003

Dig Surg

164

142

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Introduction: Open surgery for pancreatic necrosis is associated with considerable morbidity and mortality. We report the results of a recently developed minimally invasive technique that we adopted in 1998. Methods: A descriptive explanation of the approach is given together with the results of a retrospective analysis of patients who underwent a minimally invasive retroperitoneal pancreatic necrosectomy (MIRP) between August 1998 and April 2002. Patients: There were 24 patients with a median (range) age of 61 (29–75) years. The initial median (range) APACHE II score was 8 (2–21). All patients had infected pancreatic necrosis with at least 50% pancreatic necrosis. In three patients it was not possible to complete the first MIRP because of technical reasons. Results: A total of 88 procedures were performed with a median (range) of 4 (0–8) per patient. Twenty-one (88%) patients developed 36 complications during the course of their illness. Five patients required an additional open procedure: 2 for subsequent distant collections, 2 for bleeding and 1 for persisting sepsis and a distant abscess. Six (25%) patients who had MIRP died. The median (range) post-operative hospital stay was 51 (5–200) days. Conclusions: MIRP is a new technique that has shown promising results, and could be preferable to open pancreatic necrosectomy in selected patients. However, unresolved issues remain to be overcome and the exact role of MIRP in the management of pancreatic necrosis has yet to be defined.

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Section: Introductionmentioning

confidence: 98%

Minimally Invasive Retroperitoneal Pancreatic Necrosectomy

Connor¹,

Ghaneh²,

Raraty³

et al. 2003

Dig Surg

164

142

View full text Add to dashboard Cite

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“…We use the midline approach for forming the omentobursostoma in all cases of pancreatic necrosis drainage. We believe it inexpedient not to use the already made laparotomic cut as some authors recommend [10]. According to our own data, the omentobursostoma creates optimal conditions for performing delayed necrosectomy (fig.…”

Section: Discussionmentioning

confidence: 96%

Surgical Approach to Treatment of Necrotizing Pancreatitis: Early Primary Drainage without Necrosectomy. Review of Seven Recent Cases

Rubtsov

Galeev

2009

Case Rep Gastroenterol

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Unsatisfactory results of surgery in the late course of pancreatic necrosis made us search for indications and variants of operation in the early phase of the disease. As early surgical intervention, the universal approach was used in 7 patients with necrotizing pancreatitis who had a different prevalence of the inflammatory process in the retroperitoneal space. The drainage proved to be effective and enabled us to always prevent generalized infectious complications in the later phases of the disease in absence of local complications specific for open surgery: bleeding and digestive fistulas. In spite of obvious infected process development in primary open surgery, we noticed a stable decrease in procalcitonin level following the drainage. A surgical intervention has been developed enabling one to reveal in time the volume of damaged retroperitoneal fat tissue and to drain it adequately in compliance with the process prevalence, thus avoiding septic complications in the late phase of the disease. The method’s advantage involves refusal from necrosectomy in primary intervention, weekly staged revisions of the retroperitoneal space via formed contrapertures as dictated by evolution of the necrotic process in the gland.

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Retroperitoneal Approach and Endoscopic Management of Peripancreatic Necrosis Collections

Gambiez

Denimal²,

Porte³

et al. 1998

Arch Surg

113

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To review the results of the different modalities of treatment of acute necrotizing pancreatitis that have been used by a single team during a 6-year period to assess the technique and indications of an endoscopic method of retroperitoneal drainage that is routinely performed for the management of peripancreatic necrosis.Design and Setting: Retrospective study of 53 patients in a tertiary care center.Results: All patients had signs of peripancreatic necrosis on initial computed tomography scan, 20 patients experienced organ failure during the first 7 days of the disease, and bacterial contamination was proved in 22 (56%) of 39 samples of peripancreatic necrosis. Methods of treatment included supportive therapy alone (group 1), percutaneous drainage (group 2), endoscopic retroperitoneal drainage (group 3), and laparotomy and transperitoneal drainage (group 4). Mortality and mean hospital stay were as follows: group 1, 0% and 23 days; group 2, 20% and 89 days; group 3, 10% and 62 days; and group 4, 33% and 86 days. Percutaneous drainage was beneficial in only 3 cases of sterile collection. Two local complications were related to the method of endoscopic drainage. Primary laparotomy was not routinely performed except in patients with an intraperitoneal complication. Overall mortality was 13.2%; mortality was significantly higher in patients with an infected necrosis (32%). Conclusions:The use of endoscopic retroperitoneal drainage seemed to be a significant factor in the observed improvement by providing a reliable drainage of the peripancreatic areas and avoiding the opening of the peritoneal cavity. This surgical approach is not exclusive and may be combined with a secondary laparotomy when needed. The preferred indications of this method are heterogeneous collections of necrosis with bacterial contamination.

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Retroperitoneal drainage in the management of the septic phase of severe acute pancreatitis

Cited by 26 publications

References 21 publications

Minimally Invasive Retroperitoneal Pancreatic Necrosectomy

Minimally Invasive Retroperitoneal Pancreatic Necrosectomy

Surgical Approach to Treatment of Necrotizing Pancreatitis: Early Primary Drainage without Necrosectomy. Review of Seven Recent Cases

Retroperitoneal Approach and Endoscopic Management of Peripancreatic Necrosis Collections

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