[Infected necrotizing pancreatitis. Video-assisted retroperitoneal debridement]

Area of Science:

• Gastroenterology
• Surgical Innovation
• Minimally Invasive Surgery

Background:

• The step-up approach, including antibiotics and minimally invasive necrosectomy, is the standard for infected necrotizing pancreatitis.
• Video-assisted retroperitoneal debridement (VARD) is a key minimally invasive technique within this approach.

Observation:

• A case series of 5 patients (2 female, 3 male) with severe acute pancreatitis and infected pancreatic necrosis treated with the step-up approach and VARD.
• Patient ages ranged from 27 to 60; all had biliary pancreatitis with APACHE II scores from 16 to 20.
• Percutaneous drainage occurred 4-7 weeks pre-VARD, with one duodenal fistula complication. All necrotizing pancreatitis cases had positive cultures.

Findings:

• VARD procedures were performed 6-10 weeks after initial presentation; one patient needed two procedures.
• Two type B pancreatic fistulas occurred post-VARD, managed nonoperatively.
• No mortality was observed. Long-term follow-up revealed two cases of exocrine and endocrine pancreatic insufficiency.

Implications:

• VARD is a safe and effective minimally invasive necrosectomy for infected necrotizing pancreatitis.
• The step-up approach incorporating VARD yields favorable long-term outcomes.
• VARD represents a significant advancement in managing severe pancreatic necrosis.