[Infected necrotizing pancreatitis. Video-assisted retroperitoneal debridement]
Fernando Revoredo Rego1, Gustavo Reaño Paredes1, José De Vinatea De Árdenas1
1Servicio de Cirugía de Páncreas, Bazo y Retroperitoneo, Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú.
Abstract:
The step-up approach for infected necrotizing pancreatitis, consisting of broad-spectrum antibiotics, drainage followed, if necessary, by minimally invasive necrosectomy, has replaced open surgery as the standard of management. Video-assisted retroperitoneal debridement (VARD) is a surgical minimally invasive necrosectomy. This is a 5 cases series (2 female and 3 males) with severe acute pancreatitis and infected pancreatic necrosis who underwent step up approach and VARD. The age ranged from 27 to 60 years old. Al patients had biliary pancreatitis. APACHE II ranged from 16 to 20. The time to percutaneous lumbar drainage ranged from 4 to 7 weeks. There was one complication associated with percutaneous drainage (duodenal fistula) with nonoperative management. All necrotizing pancreatitis had positive cultures. The time to perform VARD ranged from 6 to 10 weeks. One patient required two procedures. There were two type B pancreatic fistulas associated with VARD, managed nonoperatively. There was no mortality. During long-term follow-up two patients were diagnosed with exocrine and endocrine pancreatic insufficiency. We conclude that VARD is a safe and effective procedure in patients with infected necrotizing pancreatitis requiring debridement, and with good long-term outcomes.
Insights
Video-assisted retroperitoneal debridement (VARD) offers a safe and effective minimally invasive necrosectomy for infected necrotizing pancreatitis. This approach demonstrates good long-term outcomes with no mortality in a case series.
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.
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