Practical strategies for case selection in minimally invasive necrosectomy.
BACKGROUND
Minimally invasive necrosectomy is an umbrella term encapsulating the retroperitoneal, endoscopic and laparoscopic approaches. However, current evidence is unclear in terms of which approach to select in any particular setting.


RESULTS
This leading article provides a pragmatic guide to approach selection in treating pancreatic necrosis with particular reference to the use of minimally invasive approaches. Current evidence in relation to timing of surgery, use of fine-needle aspiration and detailed imaging by magnetic resonance scanning is incorporated into a modern treatment algorithm.


CONCLUSIONS
The era of minimally invasive necrosectomy has arrived. In the absence of randomised trial evidence, the keys to contemporary management of pancreatic necrosis are good multidisciplinary care, adequate high-quality imaging and careful consideration of all available treatment options including traditional open approaches.
Babu
Benoy Idicula
BI
Hepatobiliary Surgical Unit, Manchester Royal Infirmary, Manchester, UK.
Siriwardena
Ajith K
AK
D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009336:Necrosis / Q000601:surgery; D010179:Pancreas / Q000473:pathology*; D010182:Pancreatic Diseases / Q000601:surgery*; D019283:Pancreatitis, Acute Necrotizing / Q000601:surgery