Minimally invasive necrosectomy for infected necrotizing pancreatitis.
OBJECTIVE
Infected necrotizing pancreatitis represents a serious and therapeutically challenging complication. Percutaneous drainage of infected pancreatic necrosis is often unsuccessful. Alternatively, open necrosectomies are associated with high morbidity. Recently, minimally invasive necrosectomy techniques have been tried with satisfying results; however, they frequently necessitate multiple sessions for definitive necrosectomy. To evaluate results of single large-port laparoscopic necrosectomy for proven infected necrotizing pancreatitis.


METHODS
Eight patients presenting proven infected pancreatic necrosis during course of acute pancreatitis and not responding to radiological drainage were prospectively offered minimally invasive necrosectomy. Laparoscopic necrosectomy were performed using a single large port placed along the drain tract directly into the infected necrosis. In all patients, drainage was placed during laparoscopic necrosectomy for continuous postoperative lavage.


RESULTS
No perioperative complications were recorded with a median operative time of 87 +/- 42 minutes. No blood transfusions were needed. No surgical postoperative morbidity and mortality were recorded. In all cases, except for one patient with multiple abscesses, only one session of necrosectomy was sufficient to completely clear the necrotic abscess. Laparoscopic necrosectomy was successful in all patients, and none required complementary surgical or radiological treatment.


CONCLUSIONS
Minimally invasive necrosectomy has been safe and highly efficient through single large-port laparoscopy for infected pancreatic necrosis in our series of patients. Minimally invasive necrosectomy is a promising technique for infected necrotizing pancreatitis and should be regarded as a valid therapeutic option for necrotizing pancreatitis.
Bucher
Pascal
P
Department of Surgery, Clinic of Visceral and Transplantation Surgery, Geneva University Hospital, Geneva, Switzerland. Pascal.Bucher@hcuge.ch
Pugin
Francois
F
Morel
Philippe
P
D000038:Abscess / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004322:Drainage; D005240:Feasibility Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008875:Middle Aged; D010179:Pancreas / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D019283:Pancreatitis, Acute Necrotizing / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents