Retroperitoneoscopic Approaches for Infected Necrotizing Pancreatitis
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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.
KeywordsSevere Acute Pancreatitis Pancreatic Necrosis Catheter Drainage Necrotizing Pancreatitis Percutaneous Catheter Drainage
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