Management of infected pancreatic necrosis using retroperitoneal necrosectomy with flexible endoscope: 10 years of experience.
BACKGROUND
This study was designed to provide our experience in the management of infected and drained pancreatic necrosis using the retroperitoneal approach.


METHODS
This was a prospective observational study in a tertiary care university hospital. Thirty-two patients with confirmed infected pancreatic necrosis were studied. Superficial necrosectomy was performed with lavage and aspiration of debris. This was achieved though a retroperitoneal approach of the pancreatic area and under the direct vision of a flexible endoscope. The follow-up procedure using retroperitoneal endoscopy did not require taking the patient to the operating room. The main outcome measures were infection control, morbidity, and mortality related to technique, reintervention, and long-term follow-up.


RESULTS
No significant morbidity or mortality related to the technique was observed in all of the patients with infected pancreatic necrosis treated with this retroperitoneal approach compared with published data using other approaches. Reinterventions were not required and patients are currently asymptomatic.


CONCLUSIONS
Retroperitoneal access of the pancreatic area is a good approach for drainage and debridement of infected pancreatic necrosis. Translumbar retroperitoneal endoscopy allows exploration under direct visual guidance avoiding open transabdominal reintervention and the risk of contamination of the abdominal cavity. This technique does not increase morbidity and mortality, can be performed at the patients' bedside as many times as necessary, and has advantages over other retroperitoneal approaches.
Department of General Surgery, Virgen de la Arrixaca University Hospital, 30120 Murcia, Spain. gcastellanos@ono.com
Gregorio
G
Castellanos
Antonio
A
Piñero
Laura A
LA
Doig
Andrés
A
Serrano
Matilde
M
Fuster
Vicente
V
Bixquert
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001424:Bacterial Infections / Q000150:complications / Q000601:surgery*; D004867:Equipment Design; D006801:Humans; D020706:Laparoscopes; D010535:Laparoscopy; D008875:Middle Aged; D009336:Necrosis / Q000601:surgery; D010179:Pancreas / Q000473:pathology* / Q000601:surgery*; D010180:Pancreatectomy / Q000379:methods*; D010182:Pancreatic Diseases / Q000150:complications / Q000382:microbiology / Q000473:pathology* / Q000601:surgery*; D011446:Prospective Studies; D013997:Time Factors