Short-Term Outcomes from a Multicenter Retrospective Study in China Comparing Laparoscopic and Open Surgery for the Treatment of Infected Pancreatic Necrosis

Abstract

Laparoscopic necrosectomy and the placement of an intermittent irrigation and continuous suction drainage system for IPN is feasible, effective, and of minimal invasiveness. The late laparoscopic necrosectomy is relatively difficult.

Therapeutic Alternatives for the Treatment of Infected Pancreatic Necrosis: An Overview

“…Three hundred eighty-nine records were recovered, 10 of which fulfilled the selection criteria: 2 SR, 1 RCT and 7 OS (Bakker et al, 2012;Bausch et al, 2012;Boland et al, 2010;Cirocchi et al, 2013;Connor et al, 2005;Guo et al, 2013;Horvath et al, 2010;Senthil Kumar et al, 2012;Tan et al, 2012;van Baal et al, 2011). The flow chart of the selected articles is detailed in Figure 1.…”

Minimally invasive techniques in the treatment of severe acute pancreatitis

“…Although no prospective randomized studies have been performed, compared with ON the laparoscopic approach has a lower incidence of pancreatic fistula, wound infection and hemorrhage, and patients have a shorter postoperative stay [37]. Figure 4 shows the algorithm proposed for the management of IPN using MIA (Figure 4).…”

“…It consists in a conventional exploratory laparoscopy with three or four ports, reaching the pancreatic cell to complete the necrosectomy and inserting large caliber drains for postoperative lavage [35,36] (Figure 3). The preferred route for accessing the pancreatic cell is via the gastro-colic ligament and greater omentum [37]. In a variant of this technique, a device is used for hand-assisted surgery to allow performance of the necrosectomy by digital blunt dissection [38].…”

“…The rate of open conversion is below 20% [36][37][38]. Based on the data reported in the literature, 80% of cases operated by laparoscopic approach will not require additional surgical procedures.…”

“…The mortality rate reported is near 10% [16]. Compared with conventional ON, the laparoscopic transperitoneal approach achieves a lower overall complication rate (particularly with regard to pancreatic fistula), lower wound infection, and shorter postoperative stay [37]. Table 1 shows the main differences of all these different MIAs, comparing indications and possible advantages and disadvantages.…”