Laparoscopic assisted percutaneous drainage of infected pancreatic necrosis.
BACKGROUND
Percutaneous drainage of infected pancreatic fluid collections is often unsuccessful. Alternatively, open necrosectomy techniques are very morbid. We hypothesized that in selected cases, laparoscopic techniques could be used to facilitate percutaneous drainage of the residual particulate necrosectum and avoid a laparotomy. We report our experience with laparoscopic assisted retroperitoneal debridement as an adjunct to percutaneous drainage for patients with infected pancreatic necrosis.


METHODS
Case studies were reviewed retrospectively. We analyzed the course of six patients undergoing laparoscopic assisted debridement of infected pancreatic necrosis after failure of percutaneous drainage. With the drains and computed tomography (CT) scan used as a guide, laparoscopic debridement of the necrosectum was performed.


RESULTS
Between November 1995 and December 1999, six patients were treated with this method. In four patients, laparoscopic assisted percutaneous drainage was successful. Two patients required open laparotomy. Complications included a self-limited enterocutaneous fistula and a small flank hernia. No deaths occurred.


CONCLUSIONS
This early, limited experience has demonstrated the feasibility of laparoscopic assisted percutaneous drainage for infected pancreatic necrosis. With this technique, two-thirds of our patients avoided the morbidity of a laparotomy.
Horvath
K D
KD
Department of Surgery, Center for Video-Endoscopic Surgery, University of Washington, 1959 NE Pacific Street, Box 356410, Seattle, WA 98195, USA. khorvath@u.washington.edu
Kao
L S
LS
Ali
A
A
Wherry
K L
KL
Pellegrini
C A
CA
Sinanan
M N
MN
D000009:Abdominal Muscles / Q000601:surgery; D000293:Adolescent; D000328:Adult; D002404:Catheterization / Q000379:methods; D004322:Drainage / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000601:surgery*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D007507:Therapeutic Irrigation / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome