DOI: http://dx.doi.org/10.18203/2349-2902.isj20211816

Two port laparoscopic retroperitoneal pancreatic necrosectomy: improvement in morbidity and mortality with a less invasive approach

Vinay H. G., Ramesh Reddy G., Shwetha Chandra R., Merin Mary, Kiran Kumar

Abstract


Background: Severe pancreatitis is associated with a high rate of mortality even with advanced surgical care and practices worldwide. Morbidity and mortality rates are much higher in the presence of infected pancreatic necrosis. From open necrosectomy, simple percutaneous drainage or one of several minimal access approaches, the question of optimal or best treatment is yet debatable. Step-up approach is currently practised by many physicians. We describe our technique of early drainage by minimal invasive two-port laparoscopic retroperitoneal pancreatic necrosectomy in our centre.

Methods: Thirteen consecutive patients with proven infected pancreatic necrosis were treated by 2P-LRPN over a two-year period in the setting of a teaching hospital. The median patient age was 44 years (range: 28-66 years) and 10 of the patients were male.

Results: The median time to discharge following the procedure of 14 days (range: 08-21 days). There was no mortality and the morbidity rate was 37%, consisting mainly of pancreatic fistula (37%).

Conclusions: Two-port laparoscopic retroperitoneal pancreatic necrosectomy is an effective and minimally invasive procedure which had better outcomes with improved patient morbidity, shorter hospital stay and lesser complication rate. Early intervention with necrosectomy has better patient compliance.


Keywords


Acute necrotising pancreatitis, Minimally invasive surgery, Pancreatic necrosectomy

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References


Bradley EL. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg. 1993;128(5):586-90.

Working Party of the British Society of Gastroenterology, Association of Surgeons of Great Britain and Ireland, Pancreatic Society of Great Britain and Ireland, Association of Upper GI Surgeons of Great Britain and Ireland. UK guidelines for the management of acute pancreatitis. Gut. 2005;54(S3):1-9.

Toouli J, Brooke SM, Bassi C, Carr LD, Telford J, Freeny P, et al. Guidelines for the management of acute pancreatitis. J Gastroenterol Hepatol. 2002;17:15-39.

Uhl W, Warshaw A, Imrie C, Bassi C, McKay CJ, Lankisch PG, et al. IAP Guidelines for the Surgical Management of Acute Pancreatitis. Pancreatology. 2002;2(6):565-73.

Traverso LW, Kozarek RA. Pancreatic necrosectomy: definitions and technique. J Gastrointest Surg. 2005;9(3):436-9.

Parekh D. Laparoscopic-assisted pancreatic necrosectomy: A new surgical option for treatment of severe necrotizing pancreatitis. Arch Surg. 2006;141(9):895-902.

Ashley SW, Perez A, Pierce EA, Brooks DC, Moore FD, Whang EE, et al. Necrotizing pancreatitis: contemporary analysis of 99 consecutive cases. Ann Surg. 2001;234(4):572-9.

Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138(1):8-13.

Lau ST, Simchuk EJ, Kozarek RA, Traverso LW. A pancreatic ductal leak should be sought to direct treatment in patients with acute pancreatitis. Am J Surg. 2001;181(5):411-5.

Park JJ, Kim SS, Koo YS, Choi DJ, Park HC, Kim JH, et al. Definitive treatment of pancreatic abscess by endoscopic transmural drainage. Gastrointest Endosc. 2002;55(2):256-62.

Raraty MG, Halloran CM, Dodd S, Ghaneh P, Connor S, Evans J, et al. Minimal access retroperitoneal pancreatic necrosectomy: improvement in morbidity and mortality with a less invasive approach. Ann Surg. 2010;251(5):787-93.

Bello B, Matthews JB. Minimally invasive treatment of pancreatic necrosis. World J Gastroenterol. 2012;18(46):6829-35.

Escourrou J, Shehab H, Buscail L, Bournet B, Andrau P, Moreau J, et al. Peroral transgastric/transduodenal necrosectomy: success in the treatment of infected pancreatic necrosis. Ann Surg. 2008;248(6):1074-80.

Horvath K, Freeny P, Escallon J, Heagerty P, Comstock B, Glickerman DJ, et al. Safety and efficacy of video-assisted retroperitoneal debridement for infected pancreatic collections: a multicenter, prospective, single-arm phase 2 study. Arch Surg. 2010;145(9):817-25.

Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010;362(16):1491-502.

Freeman ML, Werner J, Santvoort HC, Baron TH, Besselink MG, Windsor JA, et al. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas. 2012;41(8):1176-94.

Haghshenasskashani A, Laurence JM, Kwan V, Johnston E, Hollands MJ, Richardson AJ, et al. Endoscopic necrosectomy of pancreatic necrosis: a systematic review. Surg Endosc. 2011;25(12):3724-30.

Bakker OJ, Santvoort HC, Brunschot S, Geskus RB, Besselink MG, Bollen TL, et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA. 2012;307(10):1053-61.

Varadarajulu S, Christein JD, Tamhane A, Drelichman ER, Wilcox CM. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc. 2008;68(6):1102-11.

Gambiez LP, Denimal FA, Porte HL, Saudemont A, Chambon JP, Quandalle PA. Retroperitoneal approach and endoscopic management of peripancreatic necrosis collections. Arch Surg. 1998;133(1):66-72.