Three-port retroperitoneoscopic necrosectomy in management of acute necrotic pancreatitis

Abstract

Patients and methodsWe performed a retrospective analysis of eight patients who underwent a retroperitoneoscopic pancreatic necrosectomy in the Center of Abdominal Surgery, Vilnius University Hospital Santariškių Klinikos, between 2007 and 2009. There were six males and two females aged between 25 and 58 years. In seven cases, pancreatitis was caused by alcohol consumption; in one case, by gallstones. Two patients had pancreatic necrosis in the pancreatic head and tail (>50% and 30-50%), two patients had 30-50% pancreatic necrosis in the pancreatic body and tail, and four patients had >30% pancreatic necrosis in the pancreatic tail. In all cases, necrosis was proved by CT scan. Seven patients had extensive retroperitoneal phlegmon on the left side, and one patient on both sides. Operations were performed on the 21st-56th day of illness (average, 36th day), after infection of pancreatic necrosis was proved by fi ne-needle aspiration under ultrasound guidance. We used an original technique, developed in our center. A patient was placed in the right lateral decubitus position and bent at the waist with help

Retroperitoneoscopic pancreatectomy: a new surgical option for pancreatic disease

“…With regards to improvements in surgical instruments and techniques, the introduction of retroperitoneoscopy in surgeries such as adrenalectomy, nephrectomy, and pyeloureteroplasty has demonstrated the advantages of this technique, including shorter surgical access routes, simplified procedures, reduced postoperative pain levels, facilitated early postoperative mobilization, and consequently shorter hospital stay durations [10,27]. The application of retroperitoneoscopy for pancreatic diseases has been extended to necrosectomy for necrotizing pancreatitis and drainage procedures for pancreatic pseudocysts [2,8,20,23]. However, the applicability of retroperitoneoscopic resection for pancreatic lesions is still controversial [21,28,29].…”

“…Piglets have been specifically recommended as the animal model of choice [19][20][21]. Recently, reports have demonstrated the application of retroperitoneoscopic pancreatic necrosectomy for infected pancreatic necrosis [2,22]. This procedure involved pancreatic debridement through direct retroperitoneal approach.…”

“…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].…”

Minimally invasive retroperitoneal necrosectomy in management of acute necrotizing pancreatitis.

“…[1]. A patient was placed in the right lateral decubitus position and bent at the waist with the help of a roll.…”

“…All minimally invasive techniques show encouraging results. They have many advantages in comparison with open surgery such as reduced inflammatory response to intervention, considerably reduced extent of bacteriemia, reduced risk of development of multi-organ failure, reduced rate of postoperative respiratory and wound complications, shorter stay in an intensive care unit (ICU), and faster convalescence [1]. The main problem is the variety of minimally invasive methods in treatment of acute necrotizing pancreatitis.…”