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Updated: Dec 20, 2025
Author Spotlight: Advancements in Retroperitoneal Approach for Necrotizing Pancreatitis
Published on: March 15, 2024
Minimal-access retroperitoneal pancreatic necrosectomy for infected necrotizing pancreatitis: a multicentre study of
Background:
Various minimally invasive approaches have been described for infected necrotizing pancreatitis. This article describes a modified minimal-access retroperitoneal pancreatic necrosectomy (MARPN) procedure assisted by gas insufflation.
Methods:
This retrospective, observational study documented patients who had undergone a step-up MARPN between 1 January 2010 and 31 December 2016. A minimum follow-up of 1 year was required for inclusion. The step-up approach involved percutaneous catheter drainage followed by the modified MARPN and necrosectomy. If more than one access site was needed it was categorized as complex MARPN.
Results:
Of 212 patients with infected necrotizing pancreatitis, 164 (77·4 per cent) underwent a step-up approach. The median number of percutaneous catheter drains and MARPN procedures was 3 (range 1-7) and 1 (1-6) respectively. Ninety patients (54·9 per cent) underwent complex MARPN. For residual necrosis after MARPN, three patients (1·8 per cent) underwent sinus tract gastroscopy, and 11 (6·7 per cent) had sinography combined with a tube change. However, operations in 13 patients (7·9 per cent) required conversion to open surgery. Postoperative complications developed in 103 patients (62·8 per cent). The mortality rate was 6·1 per cent (10 deaths).
Conclusion:
A step-up approach using a modified MARPN for infected necrotizing pancreatitis is a reasonable option.
Insights
A modified minimal-access retroperitoneal pancreatic necrosectomy (MARPN) is a viable step-up approach for infected necrotizing pancreatitis. This minimally invasive technique offers a reasonable option for managing this complex condition.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Pancreatic Diseases
Background:
- Infected necrotizing pancreatitis presents significant management challenges.
- Minimally invasive techniques are increasingly explored for this condition.
- The modified minimal-access retroperitoneal pancreatic necrosectomy (MARPN) is a novel approach.
Purpose of the Study:
- To evaluate the efficacy and outcomes of a modified MARPN as a step-up approach.
- To assess the feasibility of MARPN in patients with infected necrotizing pancreatitis.
- To document complication rates and mortality associated with the procedure.
Main Methods:
- Retrospective observational study of patients undergoing step-up MARPN (2010-2016).
- Inclusion criteria: minimum 1-year follow-up.
- Step-up approach involved percutaneous drainage followed by MARPN; complex MARPN defined by multiple access sites.
Main Results:
- 164 of 212 patients (77.4%) underwent the step-up approach.
- Complex MARPN was performed in 54.9% of patients.
- Conversion to open surgery occurred in 7.9%, with a 6.1% mortality rate and 62.8% complication rate.
Conclusions:
- The step-up approach utilizing modified MARPN is a reasonable option for infected necrotizing pancreatitis.
- MARPN offers a minimally invasive alternative for managing pancreatic necrosis.
- Further research may optimize patient selection and procedural techniques.
