Transgastric pancreatic necrosectomy—expedited return to prepancreatitis health

Dua, Monica M.; Worhunsky, David J.; Malhotra, Lavina; Park, Walter G.; Poultsides, George A.; Norton, Jeffrey A.; Visser, Brendan C.

doi:10.1016/j.jss.2017.05.089

Cited by 13 publications

(25 citation statements)

References 29 publications

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“…In studies comparing surgical with endoscopic approach, the rate of pancreatic stula in surgical group was similar with our report [5,6]. Pancreatic stula will prolong the duration of intubation and hospital stay [25]. Additional endoscopic or surgical therapy might be required in some patients.…”

Section: Discussionsupporting

confidence: 87%

“…Furthermore, LTGN did not increase the rate of WON recurrence and other long-term complications, including new-onset diabetes and pancreatic exocrine insu ciency. Therefore, LTGN combined the advantages of less complications in endoscopic surgery and high e ciency in surgical approach [9,25]. Even in WON patients with sinistral portal hypertension, LTGN did not increas the risk of hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Transgastric Necrosectomy in Treatment of Walled-off Pancreatic Necrosis with Sinistral Portal Hypertension: A Single-Center Retrospectively Study

Feng

Zheng

et al. 2020

Preprint

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Background: Laparoscopic transgastric necrosectomy (LTGN) has been used in treatment of walled-off pancreatic necrosis (WON) for more than a decade. However, the safety and effectiveness of LTGN for WON with sinistral portal hypertension was still unclear. Methods: WON patients with sinistral portal hypertension treated in our department between Jan. 2011 and Dec. 2018 were included and retrospective analyzed in this study. Patients were divided into two groups according to different surgical approaches, LTNG or laparoscopic assisted trans-lesser sac necrosectomy (LATLSN). Perioperative and long-term outcomes were compared between two groups. Results: 312 cases diagnosed with WON were screened and 53 were finally included in this study. Of the included patients, 21 and 32 cases were received LTGN and LATLSN, respectively. LTGN was associated with significantly lower morbidity than LATLSN (19.0% vs 46.9%, p=0.04) and similar sever complication (Clavien-Dindo≥Ⅲ) rate (12.5% vs 19.0%, p=0.70). LTGN did not increase the rate of postoperative hemorrhage (9.5% vs 6.3%, p=1.00) and mortality (9.5% vs 9.4%, p=1.00). After 39(11-108) months follow-up, the recurrence rate of WON and long-term complications were also comparable between groups. Conclusions: From current data, LTGN was safe and effective in treatment of WON patients with sinistral portal hypertension in terms of short- and long-term outcomes.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Laparoscopic Transgastric Necrosectomy in Treatment of Walled-off Pancreatic Necrosis with Sinistral Portal Hypertension: A Single-Center Retrospectively Study

Feng

Zheng

et al. 2020

Preprint

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“…Results similar to ours, can be found in other authors who described the destructive forms of pancreatitis without treatment [2,6]. However, in the literature available to us, we did not meet the description of the method of treatment similar to our [1,7,12,13]. However, despite the fact that the microscopically in the pancreas of these dogs marked changes similar to those in the comparative group.…”

Section: Discussionsupporting

confidence: 82%

“…The leading role of duct hypertension in the pathogenetic mechanism of the development of acute pancreatitis is indicated by many researchers, as in the past century, and modern [3,6,8,9,10,11,12].…”

Section: Introductionmentioning

confidence: 99%

Effect of Bouginage and Washing of the Pancreatic Duct on the Course of Experimental Acute Pancreatitis

Kostyuk

Бурков

et al. 2018

Rep. of Morph.

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The presence of many hypotheses of the development of acute pancreatitis such as pancreatic duct hypertension, pancreatic reflux, vascular, allergic, neuro-reflex, infectious, etc. confirm the lack of a clear understanding of the development mechanisms of this pathology, and hence inaccuracy in the treatment and negative consequences. The purpose of this study was to investigate the effect of bouginage and flushing of the pancreatic duct on the course of experimental acute pancreatitis. Experiments were carried out on 12 dogs, for which a model of pancreatitis was created by autobile administration into the pancreas duct. Animals were divided into four groups, 3 animals per each, with the term of deduce from the test in one, three, seven days and six months respectively. Before the pancreas duct perfusion, it was injected with polyvinylchloride bougie that was removed through the incision in the distal part of the pancreas duct. Such manipulation allowed to conduct duct washing with medicinal substances at a pressure of 0.49-0.6 kPa and confirmed the assumption that in acute pancreatitis, filling of pancreas duct with condensed protein masses was observed, and this, changes the approach not only to the establishment of the pathogenetic link in the process of acute pancreatitis development, but also to its treatment. The duct was washed once. The common comprehensive drug therapy was carried out in dogs within the next five, six days. At the end of the first day, out of the 12 dogs, nine stood independently, the rest - on the second day. On the third day, all animals drank water, responded to stimuli. On the fifth day they were active, taking liquid feed. On the seventh day on their behavior and feeding manner the dogs of this group did not differ from healthy ones. To study morphological changes in pancreas after duct washing, three dogs were withdrawn from the test in one day. At autopsy effusion in peritoneal cavity was not observed. The left lobe of pancreas was a little bit shorter. Place of dissection of the tissues of the pancreas and the duct is covered with a blood clot. In the area of duodenum dissection, isolated patches of steatoenecrosis retained. Microscopically, in the duct area dissection changes in pancreas tissues, in general, were the same as in duct dissection without perfusion. At the same time, the plethora for this term was great. Necrotic centers of parenchyma were isolated and with moderate neutrophilic infiltration. Distant from the dissection zone in pancreas tissues there were minor focal hemorrhages with a violation of its structure, however, hyperplasia, foci of neutrophilic infiltration of the interstitial connective tissue were less manifestated. In the proximal part of the duct, the pancreas tissue retained moderate plethora. In addition, there were small foci of hemorrhages with a violation of the structure of individual acinus and slight neutrophilic infiltration in interstitial connective tissue. The latter was also marked by the accumulation of macrophages and the proliferation of fibroblasts, there were isolated areas of hemorrhages. In intact part there was an insignificant edema of interstitial connective tissue. As a result of the conducted experiments, we were convinced of the effectiveness of this method of treating acute pancreatitis.

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“…The advantages of a minimally-invasive approach for the treatment of pancreatic pseudocysts and WOPN are well known[8,9]. In the last decades different minimally invasive approaches have been described in literature, including endoscopic[10], laparoscopic[11,12], SILS[13] and robotic approach[5-7]. Several cases of laparoscopic drainage of pancreatic pseudocysts by cystogastrostomy have been described since the late 90s by Smadja et al[14].…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted trans-gastric drainage and debridement of walled-off pancreatic necrosis using the EndoWrist stapler for the da Vinci Xi: A case report

Morelli

Furbetta

Gianardi

et al. 2019

WJCC

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BACKGROUND Walled-off pancreatic necrosis (WOPN) is a late complication of acute pancreatitis. The management of a WOPN depends on its location and on patient's symptoms. Trans-gastric drainage and debridement of WOPN represents an important surgical treatment option for selected patients. The da Vinci surgical System has been developed to allow an easy, minimally invasive and fast surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a robotic trans-gastric drainage using the da Vinci Xi. CASE SUMMARY A 63-year-old man with an episode of acute necrotizing pancreatitis was referred to our center. Six wk after the acute episode the patient developed a walled massive fluid collection, with an extensive pancreatic necrosis, causing obstruction of the gastrointestinal tract. The patient underwent a robotic trans-gastric drainage and debridement of the WOPN performed with the da Vinci Xi platform. Firstly, an anterior ideal gastrotomy was carried out, guided by intraoperative ultrasound (US) - scan using the TilePro™ function. Then, through the gastrotomy, the best location for drainage on the posterior gastric wall was again US-guided identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was carried out with the new EndoWrist stapler with vascular cartridge. Debridement and washing of the cavity through the anastomosis were performed. Finally, the anterior gastrotomy was closed and the cholecystectomy was performed. The postoperative course was uneventful and a post-operative computed tomography-scan showed the collapse of the fluid collection. CONCLUSION In selected cases of WOPN the da Vinci Surgical System can be safely used as a valid surgical treatment option.

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Transgastric pancreatic necrosectomy—expedited return to prepancreatitis health

Cited by 13 publications

References 29 publications

Laparoscopic Transgastric Necrosectomy in Treatment of Walled-off Pancreatic Necrosis with Sinistral Portal Hypertension: A Single-Center Retrospectively Study

Laparoscopic Transgastric Necrosectomy in Treatment of Walled-off Pancreatic Necrosis with Sinistral Portal Hypertension: A Single-Center Retrospectively Study

Effect of Bouginage and Washing of the Pancreatic Duct on the Course of Experimental Acute Pancreatitis

Robot-assisted trans-gastric drainage and debridement of walled-off pancreatic necrosis using the EndoWrist stapler for the da Vinci Xi: A case report

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