title: Retroperitoneoscopic Anatomical Necrosectomy: A Modified Single-Stage Video-Assisted Retroperitoneal Approach for Treatment of Infected Necrotizing Pancreatitis.
abstract: BACKGROUND
  Video-assisted retroperitoneal necrosectomy is a minimally invasive surgical technique for the treatment of severe acute pancreatitis. This study evaluated the safety and feasibility of a modified single-stage video-assisted retroperitoneal necrosectomy, retroperitoneoscopic anatomical necrosectomy (REAN).
  
  
  METHODS
  Between September 2010 and May 2012, a total of 17 patients with infected necrotizing pancreatitis underwent REAN. The surgical procedures were similar to retroperitoneoscopic pancreatectomy, in which 3 trocars are utilized. Briefly, the perirenal space was entered through the posterior pararenal space. Dissection proceeded from posterior to anterior direction to expose the dorsal side of the perirenal fascia. This was opened to reach the anterior perirenal space, where the peripancreatic abscess was located. Necrotic tissue was then debrided and catheter drainage was performed in a single stage.
  
  
  RESULTS
  Operating time ranged from 45 to 100 minutes with minimal blood loss. All patients recovered except for one who died. Major perisurgical complications included peritoneal injury (1 patient), splenic vein injury (1 patient), retroperitoneal infection with paralytic ileus (1 patient), hydrothorax and atelectasis (2 patients), and subcutaneous cellulitis beneath the incision (3 patients). Two patients required additional percutaneous catheter drainage, and 1 patient required a laparotomy to debride the remaining necrotic tissue. Postoperative hospital stay ranged from 21 to 64 days.
  
  
  CONCLUSIONS
  This study demonstrates that REAN, a modified single-stage video-assisted retroperitoneal approach, was safe and feasible for the treatment of infected necrotizing pancreatitis. The advantages of this procedure include direct access with shorter operating time, complete necrotic tissue debridement, easy hemostasis, simple manipulation, and easy drainage.
authors.affiliation: Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
authors.forename: Guodong
authors.initials: G
authors.lastname: Zhao
authors.affiliation: Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
authors.forename: Minggen
authors.initials: M
authors.lastname: Hu
authors.affiliation: Chinese People's Liberation Army (PLA) General Hospital, Beijing, China liurong301@126.com.
authors.forename: Rong
authors.initials: R
authors.lastname: Liu
authors.affiliation: The 1st Affiliated Hospital of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Xu
mesh_terms: D000328:Adult; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D019283:Pancreatitis, Acute Necrotizing / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications; D012187:Retroperitoneal Space / Q000601:surgery*; D020535:Video-Assisted Surgery / Q000009:adverse effects* / Q000379:methods*
keywords: infected pancreatic necrosis; minimally invasive surgery; necrosectomy; necrotizing pancreatitis; retroperitoneoscopy