Related Experiment Video
Updated: Sep 29, 2025
Author Spotlight: Advancements in Retroperitoneal Approach for Necrotizing Pancreatitis
Published on: March 15, 2024
Simultaneous endoscopic and video-assisted retroperitoneal debridement in walled-off pancreatic necrosis using a
Lars Lindgaard1, Morten Laksáfoss Lauritsen1, Srdan Novovic1
1Pancreatitis Centre East (PACE), Gastro Unit,Copenhagen University Hospital-Amager and Hvidovre, Hvidovre 2650, Capital Region, Denmark.
Background:
Infected walled-off necrosis is a potentially life-threatening complication of necrotizing pancreatitis. While some patients can be treated by drainage alone, many patients also need evacuation of the infected debris. Central necroses in relation to the pancreatic bed are easily reached via an endoscopic transluminal approach, whereas necroses that involve the paracolic gutters and the pelvis are most efficiently treated via a percutaneous approach. Large and complex necroses may need a combination of the two methods.
Case Summary:
Transluminal and percutaneous drainage followed by simultaneous endoscopic and modified video-assisted retroperitoneal debridement was carried out in two patients with very large (32-38 cm), infected walled-off necroses using a laparoscopic access platform. After 34 d and 86 d and a total of 9 and 14 procedures, respectively, complete regression of the walled-off necroses was achieved. The laparoscopic access platform improved both access to the cavities as well as the overview. Simultaneous transluminal and percutaneous necrosectomy are feasible with the laparoscopic access platform serving as a useful adjunctive.
Conclusion:
This approach may be necessary to control infection and achieve regression in some patients with complex collections.
