[Indications and results of retroperitoneal laparostomy in the treatment of infected acute necrotizing pancreatitis].
The aim of this study is to describe personal experience with retroperitoneal laparostomy in the management of infected acute necrotizing pancreatitis. The presence of an infected phlegmon requires surgical debridement and drainage. The surgical approach can be either an anterior laparotomy with irrigation and drainage (which can be either an open or closed laparotomy) or a posterior laparostomy. Three patients (2 men and 1 woman) presented with an unfavourable course of their acute necrotizing pancreatitis despite the administration of broad spectrum antibiotics. A posterior laparostomy with necrosectomy and drainage was performed. The postoperative course was slowly favorable in all 3 cases. Abdominal CT is the best modality for the detection and follow-up of pancreatic necrosis. CT-guided fine needle aspiration can detect superinfection of areas of necrosis. Posterior laparostomy presents several advantages compared to an anterior approach. There is no contamination of the peritoneal cavity; the integrity of the abdominal wall is respected. The necrosectomy is equally complete and the drainage is better as it is direct and posterior.
Halkic
N
N
Service de Chirurgie, Centre Hospitalier Universitaire Vaudois, Lausanne, Suisse.
Pezzetta
E
E
Abdelmoumene
A
A
Corpataux
J M
JM
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001424:Bacterial Infections / Q000188:drug therapy / Q000601:surgery*; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D004322:Drainage; D016972:Enterobacter cloacae; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000601:surgery; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000188:drug therapy / Q000601:surgery*; D011183:Postoperative Complications; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000601:surgery; D012187:Retroperitoneal Space; D020615:Stenotrophomonas maltophilia; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
Indicazioni e risultati della laparostomia retroperitoneale nel trattamento della pancreatite acuta necrotizzante infetta.