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Retroperitoneoscopic Approaches for Infected Necrotizing Pancreatitis

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Prediction and Management of Severe Acute Pancreatitis

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Abstract

Over the last decades the treatment of severe acute pancreatitis has changed considerably. Interventional management is primarily indicated in case of infection of necrotizing pancreatitis, and intervention is postponed until pancreatic necrosis is walled-off. Minimally invasive radiological, endoscopic, and surgical techniques seem to have many advantages in comparison with open surgery.

Several techniques of minimally invasive necrosectomy have been developed to facilitate removal of infected necrosis. A retroperitoneoscopic approach is one of the most commonly used minimally invasive techniques. This chapter discusses the background, context, and techniques of retroperitoneoscopic approaches for infected necrotizing pancreatitis.

Percutaneous catheter drainage should be the first step of treatment in infected necrotizing pancreatitis. In about two-thirds of patients there is a need for additional necrosectomy. There are no randomized studies that have investigated which surgical technique for necrosectomy is superior in patients in whom percutaneous catheter drainage has failed. Sinus tract endoscopy and video-assisted retroperitoneal debridement (VARD) seem to be safe and effective retroperitoneoscopic techniques.

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Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Janneke van Grinsven M.D.

  2. Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    Marc G. Besselink M.D., Ph.D. & Marja A. Boermeester M.D., Ph.D.

  3. Department of Surgery, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, The Netherlands

    Olaf J. Bakker M.D., Sandra van Brunschot M.D. & Hjalmar C. van Santvoort M.D., Ph.D.

Authors
  1. Janneke van Grinsven M.D.
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  2. Marc G. Besselink M.D., Ph.D.
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  3. Olaf J. Bakker M.D.
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  4. Sandra van Brunschot M.D.
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  5. Marja A. Boermeester M.D., Ph.D.
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  6. Hjalmar C. van Santvoort M.D., Ph.D.
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Corresponding author

Correspondence to Hjalmar C. van Santvoort M.D., Ph.D. .

Editor information

Editors and Affiliations

  1. Division of Gastroenterology Hepatology, and Nutrition, University of Florida, Gainesville, Florida, USA

    Chris E. Forsmark

  2. Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth Pancreatic Autoislet Cell Program, Lebanon, New Hampshire, USA

    Timothy B. Gardner

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van Grinsven, J., Besselink, M.G., Bakker, O.J., van Brunschot, S., Boermeester, M.A., van Santvoort, H.C. (2015). Retroperitoneoscopic Approaches for Infected Necrotizing Pancreatitis. In: Forsmark, C., Gardner, T. (eds) Prediction and Management of Severe Acute Pancreatitis. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0971-1_15

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  • DOI: https://doi.org/10.1007/978-1-4939-0971-1_15

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  • Online ISBN: 978-1-4939-0971-1

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