Practical strategies for case selection in minimally invasive necrosectomy

Area of Science:

• Gastroenterology
• Surgical Innovation
• Minimally Invasive Surgery

Background:

• Minimally invasive necrosectomy encompasses retroperitoneal, endoscopic, and laparoscopic techniques for treating pancreatic necrosis.
• Current evidence lacks clarity on selecting the optimal minimally invasive approach for specific clinical scenarios.

Purpose of the Study:

• To provide a pragmatic guide for selecting the appropriate approach in managing pancreatic necrosis.
• To integrate current evidence on surgical timing, fine-needle aspiration, and advanced imaging into a treatment algorithm.

Main Methods:

• Review of current evidence regarding minimally invasive necrosectomy techniques.
• Development of a modern treatment algorithm incorporating imaging and procedural timing.
• Consideration of traditional open necrosectomy as a comparator.

Main Results:

• The era of minimally invasive necrosectomy for pancreatic necrosis is established.
• A treatment algorithm is proposed to guide approach selection.
• Multidisciplinary care, advanced imaging, and consideration of all options are highlighted.

Conclusions:

• Effective management of pancreatic necrosis relies on multidisciplinary collaboration.
• High-quality imaging, such as magnetic resonance scanning, is essential for treatment planning.
• Careful consideration of all therapeutic options, including open surgery, is vital in the absence of randomized trial data.