title: Retroperitoneal laparoscopic debridement and drainage of infected retroperitoneal necrosis in severe acute pancreatitis.
abstract: OBJECTIVE
  To explore the effect of retroperitoneal laparoscopic debridement and drainage on infected necrosis in severe acute pancreatitis.
  
  
  METHODS
  This retrospective study included 18 patients with severe acute pancreatitis (SAP) undergoing retroperitoneal laparoscopic debridement and drainage from May 2006 to April 2012 in our hospital. All patients had infected retroperitoneal necrosis and single or multiple peritoneal abscesses. Eleven patients transferred to our hospital were treated with the retroperitoneal laparoscopic debridement and drainage within 24-72 hours after admission. Conservative treatments were given to eight patients. Retroperitoneal laparoscopic debridement and drainage were applied 3-11 days after admission.
  
  
  RESULTS
  All patients had infection of necrotic pancreas or peripancreatic tissues. Twelve patients had organ failure. Three patients underwent secondary surgery. Laparotomy with debridement and drainage were applied to one patient who had a huge lesser sac abscess 7 days after first surgery. The other two patients were given secondary retroperitoneal laparoscopic debridement and drainage. One case was complicated by retroperitoneal hemorrhage, four cases had pancreatic leakage, and no intestinal fistula was found. The patients' heart rate, respiration, temperature, and white blood cell count were significantly improved 48 hours after surgery compared with those prior to surgery (p<0.05). The average length of stay in hospitals was 40.8 days (range, 6-121 days), and the drainage tube indwelling time was 44.4 days (range, 2-182 days).
  
  
  CONCLUSIONS
  Retroperitoneal laparoscopic debridement and drainage is an SAP surgical treatment with a minimally invasive procedure and a good effect, and can be applied for infected retroperitoneal necrosis in early SAP.
authors.affiliation: Department of Hepatobiliary Surgery, First Affiliated Hospital of People's Liberation Army (PLA) General Hospital, Beijing, China.
authors.forename: Yuliang
authors.initials: Y
authors.lastname: Tu
authors.forename: Huabo
authors.initials: H
authors.lastname: Jiao
authors.forename: Xianglong
authors.initials: X
authors.lastname: Tan
authors.forename: Dadong
authors.initials: D
authors.lastname: Wang
authors.forename: Jundong
authors.initials: J
authors.lastname: Du
authors.forename: Liyuan
authors.initials: L
authors.lastname: Sun
authors.forename: Wenzhi
authors.initials: W
authors.lastname: Zhang
mesh_terms: D000328:Adult; D000368:Aged; D003646:Debridement / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000379:methods; D004322:Drainage; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000601:surgery; D019283:Pancreatitis, Acute Necrotizing / Q000000981:diagnostic imaging / Q000601:surgery*; D012187:Retroperitoneal Space / Q000473:pathology; D012189:Retrospective Studies; D014463:Ultrasonography
keywords: debridement; drainage; laparoscopy; retroperitoneal approach; severe acute pancreatitis