 |
| necrosis from splenic hilum to pelvis |
 |
| necrosis |
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| Follow Up CT with minimal residual collection |
 |
| drainage tube |
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| minimal amount of collection after 5 days on follow up CT |
 |
| thats what patient is caring now at home . no other incision |
REVIEW ARTICLE
Current status of minimally invasive necrosectomy for
post-inflammatory pancreatic necrosis
Benoy Idicula Babu & Ajith Kumar Siriwardena
Hepatobiliary Surgical Unit, Manchester Royal Infirmary, Manchester, UK
Abstract
Objective: This paper reviews current knowledge on minimally invasive pancreatic necrosectomy.
Background: Blunt (non-anatomical) debridement of necrotic tissue at laparotomy is the standard
method of treatment of infected post-inflammatory pancreatic necrosis. Recognition that laparotomy may
add to morbidity by increasing postoperative organ dysfunction has led to the development of alternative,
minimally invasive methods for debridement. This study reports the status of minimally invasive necrosectomy
by different approaches.
Methods: Searches of MEDLINE and EMBASE for the period 1996–2008 were undertaken. Only studies
with original data and information on outcome were included. This produced a final population of 28
studies reporting on 344 patients undergoing minimally invasive necrosectomy, with a median (range)
number of patients per study of nine (1–53). Procedures were categorized as retroperitoneal, endoscopic
or laparoscopic.
Results: A total of 141 patients underwent retroperitoneal necrosectomy, of whom 58 (41%) had
complications and 18 (13%) required laparotomy. There were 22 (16%) deaths. Overall, 157 patients
underwent endoscopic necrosectomy; major complications were reported in 31 (20%) and death in seven
(5%). Laparoscopic necrosectomy was carried out in 46 patients, of whom five (11%) required laparotomy
and three (7%) died.
Conclusions: Minimally invasive necrosectomy is technically feasible and a body of evidence now
suggests that acceptable outcomes can be achieved. There are no comparisons of results, either with
open surgery or among different minimally invasive techniques.
DOI:10.1111/j.1477-2574.2009.00041.x HPB 2009,
Minimal Access Retroperitoneal Pancreatic Necrosectomy
Improvement in Morbidity and Mortality With a Less Invasive Approach
Improvement in Morbidity and Mortality With a Less Invasive Approach
Objective: Comparison of minimal access retroperitoneal pancreatic necrosectomy
(MARPN) versus open necrosectomy in the treatment of infected or
nonresolving pancreatic necrosis.
Summary of Background Data: Infected pancreatic necrosis may lead to
progressive organ failure and death. Minimal access techniques have been
developed in an attempt to reduce the high mortality of open necrosectomy.
Methods: This was a retrospective analysis on a prospective data base
comprising 189 consecutive patients undergoing MARPN or open necrosectomy
(August 1997 to September 2008). Outcome measures included total
and postoperative ICU and hospital stays, organ dysfunction, complications
and mortality using an intention to treat analysis.
Results: Overall 137 patients underwent MARPN versus open necrosectomy
in 52. Median (range) age of the patients was 57.5 (18–85) years; 118 (62%)
were male. A total of 131 (69%) patients were tertiary referrals, with a
median time to transfer from index hospital of 19 (2–76) days. Etiology was
gallstones or alcohol in 129 cases (68%); 98 of 168 (58%) patients had a
positive culture at the first procedure. Of the 137 patients, 34 (31%) had
postoperative organ failure in the MARPN group, and 39 of 52 (56%) in the
open group (P 0.0001); 59/137 (43%) versus 40/52 (77%), respectively,
required postoperative ICU support (P 0.0001). Of the 137 patients 75
(55%) had complications in the MARPN group and 42 of 52 (81%) in the
open group (P 0.001). There were 26 (19%) deaths in the MARPN group
and 20 (38%) following open procedure (P 0.009). Age (P 0.0001),
preoperative multiorgan failure (P 0.0001), and surgical procedure
(MARPN, P 0.016) were independent predictors of mortality.
Conclusion: This study has shown significant benefits for a minimal access
approach including fewer complications and deaths compared with open
necrosectomy.
Annals of Surgery • Volume 251, Number 5, May 2010
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Surgeon - Dr Keyur Bhatt - Best Gastro Surgeon
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