title: Case matched comparison study of the necrosectomy by retroperitoneal approach with transperitoneal approach for necrotizing pancreatitis in patients with CT severity score of 7 and above.
abstract: BACKGROUND
  Minimally invasive necrosectomy through a retroperitoneal approach has shown promising results for the treatment of necrotizing pancreatitis. There is however, little evidence from comparative studies in favor of these techniques over laparotomy.
  
  
  OBJECTIVE
  To perform a case matched comparison of patients with necrotizing pancreatitis who underwent necrosectomy by the retroperitoneal approach with transperitoneal approach, thus minimizing the risk of confounding and selection bias.
  
  
  METHODS
  Between August 2008 and March 2011, 85 patients were admitted with pancreatic necrosis. Each of the 15 patients who underwent necrosectomy by retroperitoneal approach using a small flank incision (RP group) were compared with 15 of those treated with necrosectomy by transperitoneal approach (TP group). These patients were matched for the age (±10 years), status of infection, CT severity score (±2 points), preoperative organ failure and timing for surgery (±7 days).
  
  
  RESULTS
  Postoperative complications occurred in 4 patients (26.6%) in the RP group and 8 (53.3%) in the TP group (p = 0.248). Reintervention, was required in 4 patients (26.6%) in the RP group and 7 (46.6%) in the TP group (p = 0.366). The median post operative ICU stay was 10 days in the RP group compared to 15 days in the TP group (p = 0.317). Median post operative hospital stay was 26 days in the RP group and 32 days in the TP group (p = 0.431). The total hospital stay among the survivors was 31 days in the RP group and 40 days in the TP group (p = 0.285).
  
  
  CONCLUSIONS
  The RP approach for pancreatic necrosectomy through a small flank incision was associated with less post operative morbidity compared to TP approach. The surgical outcomes in terms of post operative new onset organ failure and in hospital mortality were similar in both the groups, but the post op ICU/hospital stay and the total hospital stay was lower in the RP approach group. These results still requires to be confirmed by further randomized studies.
authors.affiliation: Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB diseases, Stanley Medical College Hospital, Chennai, India. dr.psenthil@yahoo.com
authors.forename: Perumal
authors.initials: P
authors.lastname: Senthil Kumar
authors.forename: P
authors.initials: P
authors.lastname: Ravichandran
authors.forename: S
authors.initials: S
authors.lastname: Jeswanth
mesh_terms: D000328:Adult; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000601:surgery*; D019283:Pancreatitis, Acute Necrotizing / Q000601:surgery*; D010529:Peritoneal Cavity / Q000601:surgery; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome