[Treatment of pancreonecrosis with lesion of retroperitoneal adipose tissue]

The results of treatment of 122 patients with pancreonecrosis (PN) with lesion of retroperitoneal fat tissue (RFT) were analyzed. Twenty-four patients underwent emergency and urgent surgery, drainage of RFT through lumbotomy was performed. Nine (37,5%) patients died. Sixty-six patients with aseptic PN were treated conservatively, 7 (10,6%) of them died. Thirty-two patients treated conservatively with infection of RFT underwent surgery with minimally invasive methods - retroperitoneoscopy with sequestrectomy, minilumbotomy, sequestrectomy. 5 (15,6%) patients died. In sterile PN conservative treatment should be carried out. Recent fluid formations in RFT are indications for thin-needle puncture, their drainage is contraindicated. Prognosis of the disease is favorable when 1-3 regions of RFT are affected, more advanced process is prognostically unfavorable. Infected PN should be treated surgically. Ultrasound-assisted drainage of purulent cavities must be performed as the first stage. Flow aspiration drainage may be a final procedure when 1-2 (rarely 3) regions of RFT are affected and large RFT sequesters are absent. Formation of large RFT sequesters requires removing with retroperitoneoscopy or through mini-approach.