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Laparoscopic Duodenum-Preserving Pancreatic Head Resection via Inferior Infracolic Approach: A Surgical Approach for Benign Lesions
Published on: February 9, 2024
Complicated Severe Acute Pancreatitis: Open and Laparoscopic Infracolic Approach
Javed Latif1, Lee Creedon2, Pritesh Mistry3
1Department of Pancreaticobiliary, Advanced Laparoscopic and Robotic Surgery, University Hospitals of Derby & Burton, Uttoxeter Road, Derby, DE22 3NE, UK. javed.latif@nhs.net.
The infracolic approach for severe acute pancreatitis (SAP) collections, including laparoscopic necrosectomy and Roux-en-Y cystjejunostomy, offers an effective surgical option. This technique provides a safe management strategy for complicated SAP when traditional methods fail.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Abdominal Surgery
Background:
- Severe acute pancreatitis (SAP) presents complex management challenges due to its heterogeneous nature.
- Central pancreatic collections, particularly at the root of the mesentery, are often inaccessible with standard surgical techniques.
Purpose of the Study:
- To evaluate the efficacy and safety of the infracolic approach for managing complicated SAP.
- To describe outcomes of laparoscopic infracolic necrosectomy (ICN) and ICN with Roux-en-Y cystjejunostomy (ICN-RYCJ).
Main Methods:
- Retrospective analysis of a prospectively maintained database (2012-2021).
- Inclusion of patients treated with infracolic necrosectomy or drainage for complicated SAP.
- Comparison of outcomes between ICN and ICN-RYCJ groups, including surgical approach (laparoscopic vs. open).
Main Results:
- Forty patients were analyzed; 9 in the ICN group and 31 in the ICN-RYCJ group.
- The median time to intervention was 22 days for ICN and 99 days for ICN-RYCJ.
- Laparoscopic surgery was performed in 31 patients, with 4 requiring post-operative intervention. Nineteen patients were discharged at two years.
Conclusions:
- The infracolic approach, with or without Roux-en-Y cystjejunostomy, is a safe and effective surgical option for complicated SAP.
- This technique is particularly valuable for managing pancreatic collections not amenable to traditional drainage or debridement methods.
