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.
In resectable pancreatic ductal adenocarcinoma, CT is not accurate overall for the prediction of nodal involvement. In a patient with presumed pancreatic carcinoma that is considered to be resectable, the depiction on CT of peripancreatic nodes should not prevent attempted curative resection.
Since it was first introduced three decades ago, computed tomography has become an important investigative tool. Conall Garvey and Rebecca Hanlon explain different types of scanners and what they are used forComputed tomography was first introduced 30 years ago and has since become an integral part of clinical practice.1 Because of rapid advances in technology few clinicians are aware of the scope and limitations of the different types of scanners. This review describes the three main types of computed tomographic scanner that are used in routine clinical practice and discusses their use in the investigation of a wide range of different conditions. It also flags up differing views on the relative merits of computed tomography versus magnetic resonance imaging.
MethodsThe information contained in this review was gathered from several sources. These include many years of personal experience using computed tomography and magnetic resonance imaging, discussions with manufacturers of equipment, and knowledge of radiation dosimetry issues, supported by a search of Medline and the Cochrane databases for systematic reviews comparing computed tomography and magnetic resonance imaging.
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