Retropancreatic approach in the treatment of pancreatic suppurations

The authors present an additional retropancreatic access path used in the treatment of suppurations that are subsequent to severe acute pancreatitis. The approach utilized by them, namely the submesocolic one, involves the performance of the decollement and reclining to the right of Treitz's angle, thus granting full access to the pancreatic compartment situated to the left of the superior mesenteric vascular pedicle. The indication for the use of this retropancreatic approach is determined on CT scan criteria, after receiving the data offered by the oral and intravenous contrast media. The ratio between the collections and Treitz's angle can be evaluated accurately. The usage of this access path is not isolated, classical approaches being concomitanlty used as a rule through the omental bursa and the retroduodenopancreatic approach. The method presented is meant to complete the range of already accepted approaches and offer some guarantee with regard to the decrease of retropancreatic suppurative processes, with the purpose of reducing either planned or selective reinterventions. The experience of the authors is still limited (12 cases), and their presentation must be appreciated as a preliminary note which impels to reflection upon a complete debridement of suppurated necroses. It offers a short and direct path to the retropancreatic space, which is often impossible to reach through the wide access path of the omental bursa.