[Transgastric necrosectomy by open surgery in necrotising acute pancreatitis]

Conventional surgery for necrotising acute pancreatitis is often associated with high mortality and morbidity rates. The aim of this study was to describe the initial experience with a new and presumed lesser invasive surgical procedure.

The outcome of patients who underwent transgastric necrosectomy and subsequent marsupialisation due to necrotising pancreatitis was registered.

Seven patients (five males, two females) with a median age of 47 years (range 32-62 years) had surgery. The reasons for pancreatitis were: gallstones (n = 4), idiopathic (n = 2) and alcohol (n = 1). The median time from onset of symptoms to surgery was 40 days (range 29-90 days). Four patients (57%) had an uneventful post-operative stay. Three patients (43%) had one or more complications requiring invasive therapy. Two of these patients needed repeated surgery. The median postoperative hospitalisation was 18 days (range 10-65 days). There was no post-operative mortality. At a three-month follow-up, one patient had exocrine pancreatic insufficiency, and one patient had both exocrine pancreatic insufficiency and diabetes mellitus.

Transgastric necrosectomy seems to be associated with a low risk of complications for selected patients with necrotising acute pancreatitis. However, further experience with the procedure is needed in order to draw valid conclusions.