Advertisement

Minimally Invasive Debridement for Infected Pancreatic Necrosis

  • Zhi Ven Fong
  • Peter J. Fagenholz
How I do it
  • 81 Downloads

Abstract

Necrotizing pancreatitis has historically been treated with open necrosectomy, which carries a high morbidity and mortality rate. More recently, there has been a shift towards endoscopic and percutaneous approaches employed as part of a minimally invasive step-up approach. Herein, we describe the technical approaches to video-assisted retroperitoneal debridement and sinus tract endoscopic debridement of pancreatic necrosis. Additionally, we review important patient selection considerations and the strengths and weaknesses of each of the approaches.

Keywords

Video-assisted retroperitoneal debridement Pancreatic necrosectomy Infected necrotizing pancreatitis 

Notes

Author Contributions

Substantial contributions to the conception or design of the work, or the acquisition, analysis, or interpretation of data for the work: ZVF and PJF

Drafting the work or revising it critically for important intellectual content: ZVF and PJF

Final approval of the version to be published: ZVF and PJF

Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: ZVF and PJF

References

  1. 1.
    Fagenholz PJ, Castillo CF, Harris NS, et al. Increasing United States hospital admissions for acute pancreatitis, 1988–2003. Ann Epidemiol 2007; 17:491–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Fagenholz PJ, Fernandez-del Castillo C, Harris NS, et al. Direct medical costs of acute pancreatitis hospitalizations in the United States. Pancreas 2007; 35:302–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Madenci AL, Michailidou M, Chiou G, et al. A contemporary series of patients undergoing open debridement for necrotizing pancreatitis. Am J Surg 2014; 208:324–31.CrossRefPubMedGoogle Scholar
  4. 4.
    Rodriguez JR, Razo AO, Targarona J, et al. Debridement and closed packing for sterile or infected necrotizing pancreatitis: insights into indications and outcomes in 167 patients. Ann Surg 2008; 247:294–9.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Carter CR, McKay CJ, Imrie CW. Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pancreatic necrosis: an initial experience. Ann Surg 2000; 232:175–80.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Alverdy J, Vargish T, Desai T, et al. Laparoscopic intracavitary debridement of peripancreatic necrosis: preliminary report and description of the technique. Surgery 2000; 127:112–4.CrossRefPubMedGoogle Scholar
  7. 7.
    Working Group IAPAPAAPG. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013; 13:e1–15.CrossRefGoogle Scholar
  8. 8.
    Uhl W, Warshaw A, Imrie C, et al. IAP Guidelines for the Surgical Management of Acute Pancreatitis. Pancreatology 2002; 2:565–73.CrossRefPubMedGoogle Scholar
  9. 9.
    Horvath KD, Kao LS, Ali A, et al. Laparoscopic assisted percutaneous drainage of infected pancreatic necrosis. Surg Endosc 2001; 15:677–82.CrossRefPubMedGoogle Scholar
  10. 10.
    Sinus Tract Endoscopic Debridement of Pancreatic Necrosis by Peter J Fagenholz, MD. Available at: https://youtu.be/e05-SVI-7rA. Accessed May 26, 2018.
  11. 11.
    Video Assisted Retroperitoneal Debridement of Pancreatic Necrosis by Peter J Fagenholz, MD. Available at: https://youtu.be/9ErPBAnrOAU. May 26, 2018.
  12. 12.
    Donald G, Donahue T, Reber HA, et al. The evolving management of infected pancreatic necrosis. Am Surg 2012; 78:1151–5.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Dugernier T, Dewaele J, Laterre PF. Current surgical management of acute pancreatitis. Acta Chir Belg 2006; 106:165–71.CrossRefPubMedGoogle Scholar
  14. 14.
    Bakker OJ, van Santvoort HC, van Brunschot S, et al. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA 2012; 307:1053–61.CrossRefPubMedGoogle Scholar
  15. 15.
    van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010; 362:1491–502.CrossRefPubMedGoogle Scholar
  16. 16.
    Petrov MS, Shanbhag S, Chakraborty M, et al. Organ failure and infection of pancreatic necrosis as determinants of mortality in patients with acute pancreatitis. Gastroenterology 2010; 139:813–20.CrossRefPubMedGoogle Scholar
  17. 17.
    van Brunschot S, van Grinsven J, Voermans RP, et al. Transluminal endoscopic step-up approach versus minimally invasive surgical step-up approach in patients with infected necrotising pancreatitis (TENSION trial): design and rationale of a randomised controlled multicenter trial [ISRCTN09186711]. BMC Gastroenterol 2013; 13:161.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Fagenholz PJ, Thabet A, Mueller PR, et al. Combined endoscopic trangastric drainage and video assisted retroperitoneal pancreatic debridement - The best of both worlds for extensive pancreatic necrosis with enteric fistulae. Pancreatology 2016.Google Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  1. 1.Department of Surgery, Massachusetts General HospitalHarvard Medical SchoolBostonUSA

Personalised recommendations