title: Retroperitoneal laparostomy: a surgical treatment of pancreatic abscesses after an acute necrotizing pancreatitis.
abstract: BACKGROUND
  From 1982 to 1988, 20 patients with pancreatic abscesses after an acute necrotizing pancreatitis underwent a retroperitoneal laparostomy (RPL).
  
  
  METHODS
  The severity of the disease was assessed by Ranson's bioclinical and Hill's computed tomographic scoring systems. The RPL, guided by the results of repeated computed tomographic scans (high frequency of peripancreatic necrotic extension through the anterior pararenal space) consists of a left or right lateral incision under the twelfth rib, allowing direct access to the pancreas and peripancreatic spaces.
  
  
  RESULTS
  Four patients (20%) had local complications: colonic fistula (one patient), gastric and colonic fistula (one patient), jejunal fistula (one patient), and local hemorrhage (one patient). Only one complication was lethal (gastric and colonic fistula). Four patients died (mortality rate 20%). In two of the cases death was related directly to a persistent sepsis after the RPL, whereas the two other patients died despite a complete surgical drainage.
  
  
  CONCLUSIONS
  RPL (left or right, sometimes bilateral) allows a total exploration of the pancreas and peripancreatic spaces in most cases, as well as a complete manual removal of the necrotic infected masses. Furthermore, several second-look removals of newly formed necrotic masses can be performed without the risk of peritoneal contamination and with a low rate of digestive fistula.
authors.affiliation: Department of Surgery, St-Luc University Hospital, Louvain-en-Woluwe Medical School, Bruxelles, Belgium.
authors.forename: E L
authors.initials: EL
authors.lastname: Van Vyve
authors.forename: M S
authors.initials: MS
authors.lastname: Reynaert
authors.forename: B G
authors.initials: BG
authors.lastname: Lengele
authors.forename: J T
authors.initials: JT
authors.lastname: Pringot
authors.forename: J B
authors.initials: JB
authors.lastname: Otte
authors.forename: P J
authors.initials: PJ
authors.lastname: Kestens
mesh_terms: D000038:Abscess / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D000208:Acute Disease; D001419:Bacteria / Q000302:isolation & purification; D010535:Laparoscopy / Q000379:methods; D009336:Necrosis; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D010195:Pancreatitis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D011183:Postoperative Complications; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome