Minimally invasive treatment of pancreatic necrosis

Bello, Brian L.; Matthews, Jeffrey B.

doi:10.3748/wjg.v18.i46.6829

Cited by 60 publications

(61 citation statements)

References 33 publications

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“…While this series does not reflect a randomised trial or even a direct comparison, the median number of procedures required per patient was 2 (range: 1-5), which is lower than most retroperitoneal necrosectomy series, where it varies from 3 to 5. 20 However, lower numbers have been reported from endoscopic, 21 transperitoneal 2 and combined approaches. 12,13 There was one death in our series of patients, which was due to respiratory complications that developed after the patient had been discharged to his local hospital and more than 90 days after the necrosectomy procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the limitations outlined above (of a descriptive series versus a trial), this compares extremely favourably with other published mortality rates following retroperitoneoscopic necrosectomy of 0-26%. 14,20 A systematic review of endoscopic necrosectomy suggested outcomes may be improved with this route compared with open or direct retroperitoneal access as overall morbidity and mortality rates were found to be 27% and 5% respectively, which was lower than with surgical minimal access methods. 17 The multicentre PENGUIN (Pancreatitis, ENdoscopic transGastric versUs primary necrosectomy in patients with Infected Necrosis) trial by the Dutch Pancreatitis Study Group randomised patients to either endoscopic or surgical necrosectomy and found endoscopic necrosectomy to be superior with significantly less new onset organ failure (0% vs 50%, p=0.03) and fewer pancreatic fistulas (10% vs 70%, p=0.02).…”

Section: Discussionmentioning

confidence: 99%

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The two-port laparoscopic retroperitoneal approach for minimal access pancreatic necrosectomy

Nageswaran

Belgaumkar

et al. 2015

annals

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INTRODUCTION Despite advances in surgery and critical care, severe pancreatitis continues to be associated with a high rate of mortality, which is increased significantly in the presence of infected pancreatic necrosis. Controversy persists around the optimal treatment for such cases, with specialist units variously advocating open necrosectomy, simple percutaneous drainage or one of several minimal access approaches. We describe our technique and outcomes with a two-port laparoscopic retroperitoneal necrosectomy (2P-LRN). METHODS Thirteen consecutive patients with proven infected pancreatic necrosis were treated by 2P-LRN over a three-year period in the setting of a specialist hepatopancreatobiliary unit. The median patient age was 46 years (range: 28-87 years) and 10 of the patients were male. RESULTS The median number of procedures required to clear the necrosis was 2 (range: 1-5), with a median time to discharge following the procedure of 44 days (range: 10-135 days). There was no 90-day mortality and the morbidity rate was 38%, consisting of pancreatic fistula (31%) and bleeding (23%). CONCLUSIONS Two-port laparoscopic retroperitoneal necrosectomy has been demonstrated to confer similar or better outcomes to other techniques for necrosectomy. It carries the additional advantages of better visualisation, leading to fewer procedures and the opportunity to deploy simple laparoscopic instruments such as diathermy or haemostatic clips.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The two-port laparoscopic retroperitoneal approach for minimal access pancreatic necrosectomy

Nageswaran

Belgaumkar

et al. 2015

annals

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“…[15] On the basis of a meta-analysis of 8 researches considering 286 patients the percutaneous drainage of infected pancreatic necrosis was efficient in 44% of them. [16] Percutaneous drainage can be exploited together with endoscopic drainage as a method of a multiple approach to the necrotic cavity, [9,14,17] particularly when it comes to penetration of necrosis down the abdominal cavity, up to the minor pelvis. [18] It was proved that the use of percutaneous drainage during endoscopic treatment of WOPN decreases the amount of endoscopic and radiological procedures as well as hospitalization time.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic transmural drainage combined with percutaneous drainage in treatment of walled-off pancreatic necrosis-case report

Jagielski

Smoczyński

Studniarek

et al. 2016

CRIM

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Pancreatic necrosis and the necrosis of surrounding tissues are found to be local complications occurring in 15% of patients suffering from acute pancreatitis. Walled-off pancreatic necrosis (WOPN) is in fact pancreatic fluid collection surrounded by a well-defined wall and inclusive of liquefied necrosis and elements (debris) of necrotic tissues. Endotherapy is an efficient method of treatment for patients with symptomatic WOPN. Often single transmural access to the necrotic collection is sufficient. However, in some patients with infected WOPN, the application of an extra way of access to pancreatic necrosis is a must. In these particular patients the optimal strategy is joining a few minimally invasive methods, which allows multiplexing of access to the collection. Herein we described the case of treatment with the use of minimally invasive techniques in a patient suffering from an infected WOPN, in which the single transmural access to the necrotic collection appeared to be insufficient and the application of an extra way of access to pancreatic necrosis was necessary. Only joining together both minimally invasive techniques-transmural drainage and percutaneous drainage had become efficient enough and led to complete healing of the patient.

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“…However, the results are often skewed by the characteristics of the study, and so there is a need for an update to establish which of the currently available techniques should be used in specific cases of INP. Based on the study of various review articles [16][17][18][19], the approaches described can be classified in four broad groups: percutaneous, retroperitoneal, laparoscopic (transperitoneal) and endoscopic (endoluminal). In turn, each of these approaches can be considered as the definitive single treatment or can be used as the initial approach in combination with others [13].…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive techniques in the treatment of severe acute pancreatitis

et al. 2014

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AbstractOpen necrosectomy, the standard surgical treatment of infected pancreatic necrosis (IPN), presents a high rate of postoperative complications and an associated mortality of 20–60%. In the last decade various minimally invasive approaches (MIA) have been proposed for the treatment of IPN and the results seem to improve on those reported with open necrosectomy. These MIA include: percutaneous, retroperitoneal, endoscopic (endoluminal) and laparoscopic (transperitoneal). The adoption of the step-up approach in the management of severe acute pancreatitis (SAP) facilitates the implementation of MIA as the surgical treatment of choice in most cases. Since MIA require the expertise of radiologists, endoscopists and surgeons, patients suffering SAP should be treated by multidisciplinary teams in referral centers. We describe the MIA currently available and discuss their advantages, disadvantages, and results.

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Minimally invasive treatment of pancreatic necrosis

Cited by 60 publications

References 33 publications

The two-port laparoscopic retroperitoneal approach for minimal access pancreatic necrosectomy

The two-port laparoscopic retroperitoneal approach for minimal access pancreatic necrosectomy

Endoscopic transmural drainage combined with percutaneous drainage in treatment of walled-off pancreatic necrosis-case report

Minimally invasive techniques in the treatment of severe acute pancreatitis

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