Single incision laparoscopic approach for infected necrotizing pancreatitis: A case report
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Updated: Dec 14, 2025
Author Spotlight: Advancements in Retroperitoneal Approach for Necrotizing Pancreatitis
Published on: March 15, 2024
N den Dekker1, A A J Grüter1, S E van Oostendorp1
1Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Location VUmc, De Boelelaan 1117, Postbus 7057, 1007 MB, Amsterdam, the Netherlands.
Introduction:
Approximately 5% of patients with acute pancreatitis develop infected necrotizing pancreatitis, with reported mortality rates up to 32%. Surgical interventions are postponed as long as possible, but if surgical debridement is needed the optimal approach has not been found yet.
Case Presentation:
A 47-year-old male was referred to our tertiary centre with infected necrotizing pancreatitis. Two months after initial presentation and repeated percutaneous drainage, surgical retroperitoneal debridement of the necrotic tissue was performed using a single incision laparoscopic surgery (SILS) port. Postoperatively, percutaneous drainage was performed two more times, but no additional surgical interventions were needed. The patient was discharged one month after the surgical procedure.
Discussion And Conclusion:
This is the first report of a minimally invasive technique using a SILS port for debridement of necrotizing pancreatitis. The ability to create a stable pneumo-retroperitoneum leads to optimal visualisation, better haemostasis, more space to operate in, better instrument handling, and better tissue control.
Insights
This study introduces a minimally invasive technique for infected necrotizing pancreatitis using a single incision laparoscopic surgery (SILS) port. This approach offers improved visualization and control for surgical debridement, potentially reducing mortality in severe pancreatitis cases.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Infected necrotizing pancreatitis affects 5% of patients with acute pancreatitis, carrying a high mortality rate (up to 32%).
- Optimal surgical debridement strategies for infected necrotizing pancreatitis remain undetermined, despite delayed intervention attempts.
Observation:
- A 47-year-old male with infected necrotizing pancreatitis underwent retroperitoneal debridement.
- The procedure utilized a single incision laparoscopic surgery (SILS) port two months after initial presentation and repeated percutaneous drainage.
Findings:
- This case report details the first use of a SILS port for minimally invasive debridement in necrotizing pancreatitis.
- The SILS port facilitated a stable pneumo-retroperitoneum, enhancing visualization, hemostasis, operative space, instrument handling, and tissue control.
Implications:
- Minimally invasive debridement using SILS port represents a novel approach for managing infected necrotizing pancreatitis.
- This technique may improve outcomes and reduce the need for further interventions in complex pancreatitis cases.
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