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Combined Laparoscopic and Choledochoscopic Necrosectomy for Infected Pancreatic Necrosis: A Case Report
Peiduo Huang1, Yichu Nie2, Shuying Su3
1Guangdong Medical University; Department of Hepatobiliary and Pancreatic Surgery, the First People's Hospital of Foshan (The Affiliated Foshan Hospital of Southern University of Science and Technology), School of Medicine, Southern University of Science and Technology.
A novel combined laparoscopic and choledochoscopic necrosectomy successfully treated extensive infected pancreatic necrosis. This minimally invasive approach offers a feasible option for complex cases refractory to standard drainage, leading to successful patient recovery.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Severe acute necrotizing pancreatitis with infected collections often requires intervention beyond initial management.
- Extensive, multiloculated infected collections, especially involving both pancreatic head and tail, pose significant treatment challenges.
- Standard percutaneous drainage and antibiotic therapy can fail in complex cases, necessitating advanced surgical strategies.
Purpose of the Study:
- To present a case of severe acute necrotizing pancreatitis with extensive infected collections refractory to conventional treatment.
- To describe the successful application of a combined laparoscopic and choledochoscopic necrosectomy for complex, pan-pancreatic necrosis.
- To evaluate the feasibility and efficacy of this combined minimally invasive approach.
Main Methods:
- A 63-year-old female patient with severe acute necrotizing pancreatitis and extensive infected collections underwent a combined laparoscopic and choledochoscopic necrosectomy.
- Laparoscopy provided access to the retroperitoneum and lesser sac for adhesiolysis and cavity entry.
- A flexible choledochoscope facilitated targeted debridement, irrigation, and debris removal within complex pancreatic regions.
- Double-lumen drains were placed for postoperative lavage and cavity management.
Main Results:
- The combined procedure achieved comprehensive debridement of extensive, multiloculated infected pancreatic necrosis in a single session.
- The surgery was completed laparoscopically without conversion to open surgery, with a 7-hour operative time and 800 mL blood loss.
- The patient experienced a successful recovery, with normalization of inflammatory markers and discharge on postoperative day 50.
- Follow-up imaging showed marked resolution of necrotic collections, with no further interventions required.
Conclusions:
- A combined laparoscopic and choledochoscopic necrosectomy is a feasible and effective minimally invasive option for complex, pan-pancreatic necrosis.
- This approach overcomes anatomical limitations of unilateral or purely endoscopic methods for extensive disease.
- The technique facilitates comprehensive debridement and management of deep, complex necrotic collections, leading to favorable patient outcomes.