Retroperitoneoscopy in the management of drained infected pancreatic necrosis

Castellanos, Gregorio; Serrano, António; Piñero, Antonio; Bru, Mariano; Párraga, M.J.; Marı́n, Pedro; Parrilla, Pascual

doi:10.1067/mge.2001.112185

Cited by 30 publications

(31 citation statements)

References 7 publications

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“…Drainage procedures, whatever their route (percutaneous, traditional, or laparoscopic), seem to work better for infected collections than for infected necrosis [39], although for the latter, repeated and proper choice of caliber of drains should also allow adequate drainage [6,24,41,74]. Recently, video-assisted retroperitoneal drainage and intracavitary transluminal debridement of peripancreatic necrosis have completed the therapeutic armamentarium [3,12,23,50]. The advantages of not opening the abdominal cavity for these necessary, effective, but otherwise devastating surgical procedures warrant further investigation.…”

Section: Laparoscopic Management Of Pancreatic Necrosismentioning

confidence: 99%

Acute biliary pancreatitis, endoscopy, and laparoscopy

2003

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Current practices for diagnosis and treatment of common bile duct stones are not evidence-based. Acute biliary pancreatitis (ABP) is a specific situation in which endoscopic procedures are either overused or misused. Pancreatitis is a poor marker for choledocholithiasis. Prognostic systems are accurate to discern those patients with ABP who do not need aggressive procedures. Patients with a benign ABP do not need an endoscopic approach. Laparoscopic common bile duct exploration is an underrated treatment for patients with choledocholithiasis. Laparoscopic approach to infected necrotic collections and pseudocysts warrant further investigations.

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Section: Laparoscopic Management Of Pancreatic Necrosismentioning

confidence: 99%

Acute biliary pancreatitis, endoscopy, and laparoscopy

2003

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“…Improvements in instrumentation and techniques have opened the possibilities for an extensive range of laparoscopic applications in patients with pancreatic diseases [2][3][4][5], including necrosectomy for necrotic pancreatitis, drainage procedures for pancreatic pseudocysts, distal resections of pancreatic tumors, and even pancreaticoduodenectomy [2,[6][7][8]. Moreover, it has been repeatedly demonstrated that laparoscopic resection of pancreatic neoplasms can produce acceptable resection margins [6,9,10].…”

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confidence: 99%

Retroperitoneoscopic pancreatectomy: a new surgical option for pancreatic disease

Zhao

Xue

et al. 2011

Surg Endosc

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The results of this preliminary study demonstrate that retroperitoneoscopic pancreatectomy, a novel surgical approach, was feasible and effective in selected patients. The advantages of this approach include acceptable operating time, insignificant blood loss, simple manipulations, minor complications, and excellent postoperative recovery time. Additionally, this study suggests that retroperitoneoscopy could also be feasible for treatment of retroperitoneal nonpancreatic diseases.

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“…In the laparotomy/CPL group, six patients died, all because of MOF. These patients had a median APACHE-II score 24 hours preoperatively of 9 (range [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20], and two of the six patients were admitted to the ICU at the time of surgery. One patient in the retroperitoneal approach group died.…”

Section: Outcomementioning

confidence: 99%

“…This technique aims at minimizing surgical stress in an already critically ill patient, thereby potentially reducing morbidity and mortality. Since then, several relatively small series (median 15 patients, range 5-46 patients) on similar ''minimally invasive'' retroperitoneal approaches have been published and have shown promising results [2][3][4][5][6][7]. Consequently, these techniques are now the preferred method of intervention in several expert centers.…”

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confidence: 99%

Case‐Matched Comparison of the Retroperitoneal Approach With Laparotomy for Necrotizing Pancreatitis

et al. 2007

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Background Minimally invasive necrosectomy through a retroperitoneal approach is gaining popularity for the treatment of necrotizing pancreatitis. There is, however, no substantial evidence from comparative studies in favor of this technique over laparotomy. The aim of this case‐matched study was to perform the first head‐to‐head comparison of necrosectomy by the retroperitoneal approach with laparotomy in patients with necrotizing pancreatitis. Methods Between 2001 and 2005, there were 15 of 841 consecutive acute pancreatitis patients who underwent necrosectomy by the retroperitoneal approach using a small flank incision. These patients were matched for the presence of preoperative organ failure, status of infection, timing of surgery, age, and computed tomography severity index score with 15 of 46 patients treated with necrosectomy by laparotomy and continuous postoperative lavage (CPL). Methods In addition to all matched preoperative characteristics, there were no significant differences in sex, preoperative intensive care unit (ICU) admission, preoperative ICU stay, preoperative APACHE‐II scores, and preoperative multiple organ failure (MOF). Postoperative complications requiring reintervention occurred in six patients in each group (p = 1.000). Postoperative new‐onset MOF occurred in 10 patients in the laparotomy/CPL group versus 2 patients in the retroperitoneal approach group (p = 0.008). Six patients died in the laparotomy/CPL group versus 1 patient in the retroperitoneal approach group (p = 0.080). Conclusions The less postoperative organ failure and the trend toward lower mortality may point to a benefit of the retroperitoneal approach over laparotomy. A randomized controlled design is, however, still required to answer definitively the question of which operative technique is preferably for patients with (infected) necrotizing pancreatitis.

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Retroperitoneoscopy in the management of drained infected pancreatic necrosis

Cited by 30 publications

References 7 publications

Acute biliary pancreatitis, endoscopy, and laparoscopy

Acute biliary pancreatitis, endoscopy, and laparoscopy

Retroperitoneoscopic pancreatectomy: a new surgical option for pancreatic disease

Case‐Matched Comparison of the Retroperitoneal Approach With Laparotomy for Necrotizing Pancreatitis

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