The two-port laparoscopic retroperitoneal approach for minimal access pancreatic necrosectomy.
BACKGROUND
Despite advances in surgery and critical care, severe pancreatitis continues to be associated with a high rate of mortality, which is increased significantly in the presence of infected pancreatic necrosis. Controversy persists around the optimal treatment for such cases, with specialist units variously advocating open necrosectomy, simple percutaneous drainage or one of several minimal access approaches. We describe our technique and outcomes with a two-port laparoscopic retroperitoneal necrosectomy (2P-LRN).


METHODS
Thirteen consecutive patients with proven infected pancreatic necrosis were treated by 2P-LRN over a three-year period in the setting of a specialist hepatopancreatobiliary unit. The median patient age was 46 years (range: 28-87 years) and 10 of the patients were male.


RESULTS
The median number of procedures required to clear the necrosis was 2 (range: 1-5), with a median time to discharge following the procedure of 44 days (range: 10-135 days). There was no 90-day mortality and the morbidity rate was 38%, consisting of pancreatic fistula (31%) and bleeding (23%).


CONCLUSIONS
Two-port laparoscopic retroperitoneal necrosectomy has been demonstrated to confer similar or better outcomes to other techniques for necrosectomy. It carries the additional advantages of better visualisation, leading to fewer procedures and the opportunity to deploy simple laparoscopic instruments such as diathermy or haemostatic clips.
Royal Surrey County Hospital NHS Foundation Trust , UK.
A B
AB
Cresswell
Royal Surrey County Hospital NHS Foundation Trust , UK.
H
H
Nageswaran
Royal Surrey County Hospital NHS Foundation Trust , UK.
A
A
Belgaumkar
Royal Surrey County Hospital NHS Foundation Trust , UK.
R
R
Kumar
Royal Surrey County Hospital NHS Foundation Trust , UK.
N
N
Menezes
Royal Surrey County Hospital NHS Foundation Trust , UK.
A
A
Riga
Royal Surrey County Hospital NHS Foundation Trust , UK.
T R
TR
Worthington
Royal Surrey County Hospital NHS Foundation Trust , UK.
N D
ND
Karanjia
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D010179:Pancreas / Q000601:surgery; D019283:Pancreatitis, Acute Necrotizing / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D012187:Retroperitoneal Space / Q000601:surgery*
Acute necrotising pancreatitis; Debridement methods; Minimally invasive surgery; Necrosis; Pancreas