Minimally invasive techniques in pancreatic necrosis

Area of Science:

• Gastroenterology
• Surgical Innovation
• Interventional Radiology

Background:

• Traditional open surgical necrosectomy for infected pancreatic necrosis carries high morbidity and mortality rates.
• This has driven a shift towards less invasive treatment modalities.
• Percutaneous drainage offers temporizing sepsis control but requires frequent interventions.

Purpose of the Study:

• To review and compare minimally invasive approaches for managing infected pancreatic necrosis.
• To highlight the advantages and limitations of endoscopic, radiologic, and laparoscopic techniques.

Main Methods:

• Review of percutaneous drainage, endoscopic transgastric/transduodenal necrosectomy, laparoscopic necrosectomy, and retroperitoneal approaches.
• Discussion of the "delay-until-liquefaction" strategy for retroperitoneal drainage.
• Consideration of patient selection, anatomical factors, and operator expertise.

Main Results:

• Endoscopic necrosectomy shows high success in selected patients, avoiding open surgery and benefiting poor surgical candidates.
• Laparoscopic necrosectomy is promising but limited by pneumoperitoneum and infection risk in critically ill patients.
• Retroperitoneal access and drainage strategies are also effective, offering direct necrosis removal.

Conclusions:

• Minimally invasive procedures are increasingly utilized in tertiary care centers for pancreatic necrosis management.
• The optimal approach depends on necrosis location, patient comorbidities, and surgical expertise.
• These techniques aim to improve outcomes and reduce the risks associated with traditional open surgery.