Laparoscopy-assisted open cystogastrostomy and pancreatic debridement for necrotizing pancreatitis (with video).
BACKGROUND
Pancreatic pseudocysts and walled-off necrosis are well-known complications, described in 10% of cases of acute pancreatitis. Open cystogastrostomy is usually proposed after failure of minimally invasive drainage or in the presence of septic shock. The objective of this study was to evaluate the feasibility and efficacy of laparoscopy-assisted open cystogastrostomy for treatment of symptomatic pancreatic pseudocyst with pancreatic necrosis.


METHODS
Between January 2011 and October 2014, all patients with pseudocyst and pancreatic necrosis undergoing open cystogastrostomy were included. Surgical procedure was standardized. The primary efficacy endpoint was the feasibility and efficacy of laparoscopy-assisted open cystogastrostomy as treatment of symptomatic pancreatic pseudocyst. Secondary endpoints included demographic data, preoperative management, operative data, postoperative data and follow-up.


RESULTS
Laparoscopy-assisted open cystogastrostomy was performed in 11 patients [six men (54%)], with a median age of 61 years (45-84). Nine patients received preoperative radiological or endoscopic management. First-line open cystogastrostomy was performed in two cases. Median operating time was 190 min (110-240). There was one intraoperative complication related to injury of a branch of the superior mesenteric vein. There were no postoperative deaths and two postoperative complications (18%) including one major complication (postoperative bleeding). The median length of hospital stay after surgery was 16 days (7-35). The median follow-up was 10 months (2-45). One patient experienced recurrence during follow-up.


CONCLUSIONS
Open cystogastrostomy for necrotizing pancreatitis promotes adequate internal drainage with few postoperative complications and a short length of hospital stay. However, this technique must be performed very cautiously due to the risk of vascular injury which can be difficult to repair in the context of severe local inflammation related to pancreatic necrosis.
Department of Digestive Surgery, Hôpital Sud, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France.
Olivier
O
Gerin
Department of Digestive Surgery, Hôpital Sud, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France.
Flavien
F
Prevot
Department of Digestive Surgery, Hôpital Sud, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France.
Abdennaceur
A
Dhahri
Department of Gastroenterology, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France.
Sami
S
Hakim
Department of Gastroenterology, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France.
Richard
R
Delcenserie
Department of Digestive Surgery, Hôpital Sud, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France.
Lionel
L
Rebibo
Department of Digestive Surgery, Hôpital Sud, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France. regimbeau.jean-marc@chu-amiens.fr.|EA4294, Jules Verne University of Picardie, 80054, Amiens Cedex 01, France. regimbeau.jean-marc@chu-amiens.fr.|Clinical Research Center, Amiens University Hospital, Avenue René Laennec, 80054, Amiens Cedex 01, France. regimbeau.jean-marc@chu-amiens.fr.
Jean-Marc
JM
Regimbeau
D000368:Aged; D000369:Aged, 80 and over; D003646:Debridement / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D019283:Pancreatitis, Acute Necrotizing / Q000601:surgery*; D011183:Postoperative Complications
Laparoscopy-assisted; Open cystogastrostomy; Pancreatic necrosis; Pancreatic pseudocyst