title: Internal drainage of giant acute pseudocysts: the role of video-assisted pancreatic necrosectomy.
abstract: BACKGROUND
  Internal drainage of giant pancreatic pseudocysts secondary to acute pancreatitis is frequently complicated with postoperative retroperitoneal infection and hemorrhage. Recent data suggest that the risk factor is unrecognized pancreatic necrosis; presumably, pancreatic necrosis becomes infected with bacteria introduced by the cystoenteric anastomosis.
  
  
  OBJECTIVE
  Video-assisted pancreatic necrosectomy, performed at the time of internal drainage, may prevent postoperative retroperitoneal complications in patients with giant acute pseudocysts.
  
  
  METHODS
  A consecutive case-series.
  
  
  METHODS
  An urban, university-affiliated, tertiary referral center.
  
  
  METHODS
  Ten consecutive patients with acute pseudocysts measuring 10 cm or more in major diameter. The mean extent of pancreatic necrosis, as shown by contrast-enhanced computed tomography, was 50%. All patients were operated on electively, at an average time of 7.7 weeks from onset of the attack to surgical treatment.
  
  
  METHODS
  Through a midline incision, a 4-cm opening is made at the base of the pseudocyst. Standard laparoscopic instruments are introduced into the pseudocyst and video-assisted pancreatic necrosectomy is performed. The opening is then anastomosed to a Roux-en-Y limb of the jejunum.
  
  
  METHODS
  Feasibility and safety of video-assisted pancreatic necrosectomy, postoperative morbidity and mortality, hospital stay, and resolution of pseudocysts.
  
  
  RESULTS
  Complete necrosectomy was safely performed throughout. There were neither postoperative retroperitoneal complications nor mortality. Mean hospital stay was 8.2 days and all pseudocysts resolved at a mean follow-up of 6.9 months.
  
  
  CONCLUSIONS
  Video-assisted pancreatic necrosectomy at the time of internal drainage seems to prevent postoperative retroperitoneal complications in patients with giant acute pseudocysts. Depending on appropriate surgical timing, video-assisted necrosectomy is a feasible and safe procedure.
authors.affiliation: Department of Surgery, Cosme Argerich Hospital, Buenos Aires, Argentina. cbazterrica@abaconet.com.ar
authors.forename: A
authors.initials: A
authors.lastname: Oría
authors.forename: C
authors.initials: C
authors.lastname: Ocampo
authors.forename: H
authors.initials: H
authors.lastname: Zandalazini
authors.forename: L
authors.initials: L
authors.lastname: Chiappetta
authors.forename: C
authors.initials: C
authors.lastname: Morán
mesh_terms: D000328:Adult; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010179:Pancreas / Q000473:pathology / Q000601:surgery*; D010192:Pancreatic Pseudocyst / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D020535:Video-Assisted Surgery