[Video-assisted retroperitoneal debridement : Minimally invasive treatment and long-term results for necrotizing pancreatitis].
BACKGROUND
Among patients with necrotizing pancreatitis 15-20% develop infected necrosis, which entails mortality rates of up to 20%. Particularly driven by the results of the Dutch Pancreatitis Study Group there has been a paradigm change from open necrosectomy to step-up treatment with initial percutaneous and/or endoscopic drainage followed, if necessary, by minimally invasive retroperitoneal debridement.


OBJECTIVE
Description of case series in which patients underwent video-assisted retroperitoneal debridement (VARD) including follow-up focused on quality of life.


METHODS
Systematic cohort study including all patients who underwent a VARD procedure at the Department of General, Visceral and Transplantation Surgery at Aachen University Hospital from 2011 to 2015. Quality of life was recorded using the EORTC QLQ-C 30 questionnaire and compared to a representative sample of the German general population.


RESULTS
The VARD procedure was performed in 9 cases, although in 1 case conversion to an open approach due to an acute bleeding was necessary. There was no 30-day and 60-day mortality following VARD. During the postoperative stay no patient required specific treatment for surgical complications. In particular, no enterocutaneous fistula or organ perforation was observed. Regarding the quality of life score there was no significant difference concerning the global health status, compared to the sample from the general population.


CONCLUSIONS
Our data reinforce that a step-up approach in patients with necrotizing pancreatitis is a feasible and safe treatment procedure. For the first time, we could demonstrate satisfactory results in a long-term follow-up including QOL.
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland. reickhoff@ukaachen.de.
R M
RM
Eickhoff
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
J
J
Steinbusch
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
P
P
Seppelt
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
A
A
Kroh
Klinik für Allgemein-, Viszeral- und Minimalinvasive Chirurgie, Medizinisches Zentrum der Städte Region Aachen, Aachen, Deutschland.
K
K
Junge
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
C D
CD
Klink
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
U P
UP
Neumann
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Uniklinik RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.
M
M
Binnebösel
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D061887:Conversion to Open Surgery; D003646:Debridement / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D019283:Pancreatitis, Acute Necrotizing / Q000401:mortality / Q000601:surgery*; D011788:Quality of Life; D012187:Retroperitoneal Space / Q000601:surgery*; D016019:Survival Analysis; D020535:Video-Assisted Surgery / Q000379:methods*
Necrosectomy; Necrotizing pancreatitis; Pancreatic necrosis; Step-up treatment; Video-assisted retroperitoneal debridement