Hepatobiliary Surgical Unit, Manchester Royal Infirmary, Manchester, UK
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
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.
Received 31 October 2008; accepted 27 January 2009
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