title: Outcome of video-assisted translumbar retroperitoneal necrosectomy and closed lavage for severe necrotizing pancreatitis.
abstract: OBJECTIVE
  Surgery for necrotizing pancreatitis is associated with a high rate of morbidity and mortality. We present a series of 26 patients who underwent video-assisted translumbar retroperitoneal necrosectomy and analyse their outcomes.
  
  
  METHODS
  Records of 26 patients who underwent video-assisted translumbar retroperitoneal necrosectomy and closed drainage for infected pancreatitic necrosis between January 2008 and March 2012 were reviewed, retrospectively.
  
  
  RESULTS
  Twenty-three out of 26 patients were males, with a mean age of 38.6 (±9.9) years. Alcohol was the aetiology in 18 patients, gall stones in 7, and in 1 it was idiopathic. The mean duration of symptoms before patients were taken up for surgery was 47.2 (±34.8) days. The mean computed tomography severity index was 7.7 (±1.2). All patients had undergone video-assisted retroperitoneal necrosectomy through a limited left lumbar incision. Post-operative lavage was given through drains placed in the retroperitoneum. Three patients required re-exploration. Eleven patients developed complications and there were two mortalities. The median intensive care unit (ICU) stay was 4 days (range 2-14 days). The mean post-operative hospital stay was 22.5 (±6.6) days.
  
  
  CONCLUSIONS
  Video-assisted translumbar retroperitoneal necrosectomy followed by closed lavage of infected pancreatic necrosis in select cases of infected pancreatic necrosis was associated with a low rate of ICU stay, hospital stay and need for re-entry.
authors: Institute of Surgical Gastroenterology and Liver Transplantation, Government Stanley Medical College, Chennai, India.
authors: Srinivasan
authors: S
authors: Ulagendra Perumal
authors: Sastha Ahanatha
authors: SA
authors: Pillai
authors: Senthilkumar
authors: S
authors: Perumal
authors: Jeswanth
authors: J
authors: Sathyanesan
authors: Ravichandran
authors: R
authors: Palaniappan
mesh_terms: D000328:Adult; D003646:Debridement / Q000379:methods*; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008161:Lumbosacral Region; D008297:Male; D008875:Middle Aged; D019283:Pancreatitis, Acute Necrotizing / Q000601:surgery*; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D012720:Severity of Illness Index; D007507:Therapeutic Irrigation / Q000379:methods; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000379:methods*
keywords: VARD; acute necrotizing pancreatitis; infected pancreatic necrosis; minimally invasive pancreatic necrosectomy; retroperitoneal necrosectomy