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Multimedia article. Laparoscopic infracolic necrosectomy for infected pancreatic necrosis
1Surgical Skills Unit, Ninewells Hospital and Medical School, University of Dundee, Scotland, United Kingdom.
Abstract:
Infected pancreatic necrosis carries a high morbidity and mortality from sepsis and multisystem organ failure. Following confirmation of the infection by CT-guided fine needle aspiration, treatment consists of broad spectrum antibiotics (imipenim-cilastin) followed by emergency open (laparotomy) digital necrosectomy and insertion of drains for postoperative lavage with hyperosmolar dialysate as advocated by Beger et al. This video shows an alternative laparoscopic technique to open necrosectomy and has been used in Dundee since 1994. After elevation of the transverse colon, the lesser sac is opened through the root of the transverse colon between the middle and left colic vessels. The necrosectomy is accomplished from inside the lesser sac under vision with a combination of pulsed irrigation and graspers. On completion of the necrosectomy, two large drains are inserted into the lesser sac for postoperative irrigation. The experience with this technique has been favorable with a patient survival of 85%.
Insights
This study presents a laparoscopic approach for infected pancreatic necrosis, a condition with high mortality. The minimally invasive technique achieved an 85% patient survival rate, offering a favorable alternative to open surgery.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Minimally Invasive Surgery
Background:
- Infected pancreatic necrosis presents significant morbidity and mortality due to sepsis and organ failure.
- Standard treatment involves antibiotics, open necrosectomy (laparotomy), and postoperative lavage.
- Beger et al. advocated for open necrosectomy with hyperosmolar dialysate lavage.
Purpose of the Study:
- To demonstrate an alternative laparoscopic technique for infected pancreatic necrosis.
- To evaluate the efficacy and outcomes of this minimally invasive approach.
Main Methods:
- Laparoscopic necrosectomy performed within the lesser sac after opening through the transverse colon.
- Utilized pulsed irrigation and graspers for debridement under direct vision.
- Insertion of two large drains for postoperative lavage with hyperosmolar dialysate.
Main Results:
- The laparoscopic technique was successfully implemented in Dundee since 1994.
- Achieved a favorable patient survival rate of 85% in experienced cases.
Conclusions:
- Laparoscopic necrosectomy is a viable and effective alternative to open surgery for infected pancreatic necrosis.
- This minimally invasive approach offers favorable patient outcomes and survival rates.
