title: Laparoscopic necrosectomy in acute necrotizing pancreatitis: Our experience.
abstract: BACKGROUND
  Pancreatic necrosis is a local complication of acute pancreatitis. The development of secondary infection in pancreatic necrosis is associated with increased mortality. Pancreatic necrosectomy is the mainstay of invasive management.
  
  
  OBJECTIVE
  Surgical approach has significantly changed in the last several years with the advent of enhanced imaging techniques and minimally invasive surgery. However, there have been only a few case series related to laparoscopic approach, reported in literature to date. Herein, we present our experience with laparoscopic management of pancreatic necrosis in 28 patients.
  
  
  METHODS
  A retrospective study of 28 cases [20 men, 8 women] was carried out in our institution. The medical record of these patients including history, clinical examination, investigations, and operative notes were reviewed. The mean age was 47.8 years [range, 23-70 years]. Twenty-one patients were managed by transgastrocolic, four patients by transgastric, two patients by intra-cavitary, and one patient by transmesocolic approach.
  
  
  RESULTS
  The mean operating time was 100.8 min [range, 60-120 min]. The duration of hospital stay after the procedure was 10-18 days. Two cases were converted to open (7.1%) because of extensive dense adhesions. Pancreatic fistula was the most common complication (n = 8; 28.6%) followed by recollection (n = 3; 10.7%) and wound infection (n = 3; 10.7%). One patient [3.6%] died in postoperative period.
  
  
  CONCLUSIONS
  Laparoscopic pancreatic necrosectomy is a promising and safe approach with all the benefits of minimally invasive surgery and is found to have reduced incidence of major complications and mortality.
authors.affiliation: Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospital, Chennai, Tamil Nadu, India.
authors.forename: Mittu John
authors.initials: MJ
authors.lastname: Mathew
authors.affiliation: Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospital, Chennai, Tamil Nadu, India.
authors.forename: Amit Kumar
authors.initials: AK
authors.lastname: Parmar
authors.affiliation: Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospital, Chennai, Tamil Nadu, India.
authors.forename: Diwakar
authors.initials: D
authors.lastname: Sahu
authors.affiliation: Department of Surgical Gastroenterology and Minimal Access Surgery, Apollo Hospital, Chennai, Tamil Nadu, India.
authors.forename: Prasanna Kumar
authors.initials: PK
authors.lastname: Reddy
keywords: Laparoscopic necrosectomy; necrotizing pancreatitis; retroperitoneal; transgastric; transluminal