title: Minimally invasive retroperitoneal necrosectomy in management of acute necrotizing pancreatitis.
abstract: BACKGROUND
  One of the most important requirements in treatment of acute necrotizing pancreatitis is minimized invasion.
  
  
  OBJECTIVE
  We are presenting experience in treatment of acute necrotizing pancreatitis by an original minimally invasive retroperitoneal necrosectomy technique, comparing our results to other studies, evaluating feasibility and safety, discussing advantages and disadvantages of this method.
  
  
  METHODS
  We performed a retrospective analysis of 13 patients who had acute necrotizing pancreatitis with large fluid collections in retroperitoneal space and underwent retroperitoneal necrosectomy.
  
  
  RESULTS
  There were eight males and three females aged between 24 and 60 years, average age was 42.8 ±9.2 years. The most common cause of pancreatitis was alcohol, 10 patients (76.9%). Average time between diagnosis and performance of operation was 25.7 ±11.3 days. One patient underwent eight repeated interventions: two retroperitoneal necrosectomies; five laparotomies; ultrasound-guided drainage. One patient underwent four reinterventions: lumbotomy; revision; two lavages. Three patients had two reinterventions: one had laparotomy and tamponation; one had two repeated retroperitoneal necrosectomies; third had one repeated retroperitoneal necrosectomy and one had ultrasound-guided drainage. Three patients needed one additional retroperitoneal necrosectomy. Five patients did not required additional interventions. 61.5% of our patients did not require more than one reintervention. Postoperative stay varied from 9 to 94 days, average 50.8 ±32.6 days.
  
  
  CONCLUSIONS
  Minimally invasive techniques should be considered as first-choice surgical option in treating patients with acute necrotizing pancreatitis. Pancreatic necrosis occupying less than 30% and with massive fluid collections in the left retroperitoneal space can be safely managed by minimally invasive retroperitoneal necrosectomy.
authors: Clinic of Gastroenterology, Nephrourology and Surgery, Faculty of Medicine, Vilnius University, Lithuania.
authors: Audrius
authors: A
authors: Sileikis
authors: Virgilijus
authors: V
authors: Beiša
authors: Augustas
authors: A
authors: Beiša
authors: Artūras
authors: A
authors: Samuilis
authors: Mindaugas
authors: M
authors: Serpytis
authors: Kęstutis
authors: K
authors: Strupas
keywords: minimally invasive pancreatic necrosectomy; necrotizing pancreatitis; retroperitoneal necrosectomy; retroperitoneoscopy
references: Dig Dis Sci. 2006 Aug;51(8):1388-95
references: 16855881
references: Ann Surg. 2010 May;251(5):787-93
references: 20395850
references: HPB (Oxford). 2009 Mar;11(2):96-102
references: 19590631
references: Gastroenterology. 2011 Oct;141(4):1254-63
references: 21741922
references: Ann Surg. 2000 Aug;232(2):175-80
references: 10903593
references: Arch Surg. 2005 Oct;140(10):952-5
references: 16230544
references: Gastroenterol Clin Biol. 2004 Oct;28(10 Pt 1):868-71
references: 15523223
references: Surg Endosc. 2005 Mar;19(3):393-7
references: 15573237
references: Surgery. 2005 May;137(5):499-505
references: 15855920
references: Pancreas. 2009 Nov;38(8):867-75
references: 19855233
references: N Engl J Med. 2010 Apr 22;362(16):1491-502
references: 20410514
references: Medicina (Kaunas). 2010;46(3):176-9
references: 20516756
references: Pancreas. 2008 Mar;36(2):113-9
references: 18376300
references: Arch Surg. 1998 Jan;133(1):66-72
references: 9438762
references: World J Surg. 2007 Aug;31(8):1635-42
references: 17572838
references: BMC Surg. 2006 Apr 11;6:6
references: 16606471
references: Curr Opin Crit Care. 2010 Apr;16(2):153-8
references: 20075722
references: Surg Laparosc Endosc Percutan Tech. 2010 Feb;20(1):e11-5
references: 20173602
references: Expert Rev Gastroenterol Hepatol. 2010 Dec;4(6):701-8
references: 21108589
references: Singapore Med J. 2007 Aug;48(8):e220-3
references: 17657370