Current status of minimally invasive necrosectomy for post-inflammatory pancreatic necrosis
Benoy Idicula Babu1, Ajith Kumar Siriwardena
1Hepatobiliary Surgical Unit, Manchester Royal Infirmary, Manchester, UK.
Objective:
This paper reviews current knowledge on minimally invasive pancreatic necrosectomy.
Background:
Blunt (non-anatomical) debridement of necrotic tissue at laparotomy is the standard method of treatment of infected post-inflammatory pancreatic necrosis. Recognition that laparotomy may add to morbidity by increasing postoperative organ dysfunction has led to the development of alternative, minimally invasive methods for debridement. This study reports the status of minimally invasive necrosectomy by different approaches.
Methods:
Searches of MEDLINE and EMBASE for the period 1996-2008 were undertaken. Only studies with original data and information on outcome were included. This produced a final population of 28 studies reporting on 344 patients undergoing minimally invasive necrosectomy, with a median (range) number of patients per study of nine (1-53). Procedures were categorized as retroperitoneal, endoscopic or laparoscopic.
Results:
A total of 141 patients underwent retroperitoneal necrosectomy, of whom 58 (41%) had complications and 18 (13%) required laparotomy. There were 22 (16%) deaths. Overall, 157 patients underwent endoscopic necrosectomy; major complications were reported in 31 (20%) and death in seven (5%). Laparoscopic necrosectomy was carried out in 46 patients, of whom five (11%) required laparotomy and three (7%) died.
Conclusions:
Minimally invasive necrosectomy is technically feasible and a body of evidence now suggests that acceptable outcomes can be achieved. There are no comparisons of results, either with open surgery or among different minimally invasive techniques.
Insights
Minimally invasive pancreatic necrosectomy is a feasible treatment for infected pancreatic necrosis. Evidence suggests acceptable outcomes, though direct comparisons between techniques are lacking.
Area of Science:
- Gastroenterology and Surgical Innovation
- Minimally Invasive Surgical Techniques
Background:
- Open necrosectomy for infected pancreatic necrosis carries significant morbidity.
- Minimally invasive approaches have emerged to reduce complications associated with traditional laparotomy.
- This review examines the current status and outcomes of various minimally invasive necrosectomy methods.
Purpose of the Study:
- To review and synthesize current knowledge on minimally invasive pancreatic necrosectomy.
- To report on the outcomes of different minimally invasive necrosectomy approaches.
Main Methods:
- Systematic literature search of MEDLINE and EMBASE (1996-2008).
- Inclusion of studies with original data and outcome information.
- Categorization of procedures into retroperitoneal, endoscopic, and laparoscopic approaches.
Main Results:
- Retroperitoneal necrosectomy (141 patients): 41% complications, 13% required laparotomy, 16% mortality.
- Endoscopic necrosectomy (157 patients): 20% major complications, 5% mortality.
- Laparoscopic necrosectomy (46 patients): 11% required laparotomy, 7% mortality.
Conclusions:
- Minimally invasive pancreatic necrosectomy is technically achievable.
- Current evidence indicates that acceptable patient outcomes can be obtained.
- Further comparative studies are needed to evaluate different minimally invasive techniques and compare them to open surgery.
