Laparoscopic necrosectomy

INTRODUCTION: The objective of this study is to evaluate the role of minimally invasive surgery for the management of necrotising pancreatitis in acute settings and to propose tailor-made approaches to deal with various locations of pancreatic necrosis. PATIENTS AND METHODS: Three hundred and thirteen patients underwent laparoscopic management of necrotising pancreatitis in this study period from January 2010 to June 2021, out of which 122 patients underwent minimally invasive necrosectomy for acute necrotising pancreatitis...

The surgical treatment of acute necrotizing pancreatitis has significantly evolved in recent years with the advent of enhanced imaging techniques and minimally invasive surgery. Various minimally invasive techniques, such as video-assisted retroperitoneal debridement (VARD) and endoscopic transmural necrosectomy (ETN), have been employed in the management of acute necrotizing pancreatitis and are often part of step-up approaches. However, almost all reported step-up approaches only employ a fixed minimally invasive technique prior to open surgery...

BACKGROUND: Pancreatic trauma is an uncommon injury that occurs usually in a young population and is frequently overlooked and not readily appreciated on initial examination. Nowadays, the diagnosis and management of pancreatic trauma are still controversial, and there is no gold standard for the treatment. The aim of this study is to describe our experience in the management of blunt pancreatic trauma with a laparoscopic approach and review the literature on laparoscopic management of pancreatic trauma...

Walled-off necrosis is a well-recognized complication of necrotizing pancreatitis that can cause sepsis, luminal or ductal obstruction, or persistent unwellness requiring multidisciplinary care. Recent data suggest that minimally invasive endoscopic treatment strategies are preferred over more invasive surgical approaches. Although endoscopic transmural drainage with or without necrosectomy is the primary approach for patients requiring an intervention, for collections not amenable to endoscopic approach, percutaneous drain placement followed by video-assisted retroperitoneal debridement or laparoscopic cystogastrostomy with internal debridement are other alternatives...

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Outcomes from some recent clinical trials have helped to improve the management of necrotizing pancreatitis over the last 2 decades. The location of the retroperitoneal collection, previous gastric surgery, patient preference, and medical expertise dictates a minimally invasive surgical step-up versus endoscopic approach. Endoscopic drainage is facilitated by either a plastic or metallic stent. Direct endoscopic necrosectomy is performed for lack of improvement after endoscopic drainage. The surgical approach is accomplished by minimally invasive surgery with either video-assisted retroperitoneal debridement or laparoscopic drainage...

AIM: This review aims to summarize the state of the art in endoscopic and other minimally invasive technique for the treatment of acute biliary pancreatitis. Current indications, advantages or disadvantages for each reported technique and future perspectives are discussed. BACKGROUND: Acute biliary pancreatitis is one of the most common gastroenterological diseases. Its management range from medical to interventional treatment and involves gastroenterologists, nutritionists, endoscopists, interventional radiologists and surgeons...

BACKGROUND: With recent studies demonstrating the efficacy of minimally invasive approaches following infected necrotizing pancreatitis, latest guideline recommendations support their use. However, large scale studies are lacking and the national landscape following these guidelines remains poorly characterized. The present study examined trends in intervention strategies and the association of approach on clinical outcomes and resource use in a nationally representative cohort. METHODS: The 2016-2019 National Inpatient Sample was queried for adult hospitalizations for pancreatitis with infected necrosis...

Necrotizing or severe pancreatitis represents approximately 10%-20% of acute pancreatitis. 30%-40% of patients with acute necrotizing pancreatitis (ANP) will develop debris infection through translocation of intestinal microbial flora. Infected ANP constitutes a serious clinical condition and is complicated by severe sepsis with high mortality rates of up to 40% despite progress in current intensive care. The timely detection of sepsis is crucial. The Quick Sequential Organ Failure Assessment score, procalcitonin levels > 1...

BACKGROUND: The surgical step-up approach often requires multiple debridements and might not be suitable for infected pancreatic necrosis (IPN) patients with various abscesses or no safe route for percutaneous catheter drainage (PCD). This case-control study aimed to investigate the safety and effectiveness of one-step laparoscopic pancreatic necrosectomy (LPN) in treating IPN. METHODS: This case-control study included IPN patients undergoing one-step LPN or surgical step-up in our center from January 2015 to December 2020...

INTRODUCTION: The heterogeneous nature of severe acute pancreatitis (SAP) renders decisions related to complications challenging. Central solid collections at the root of the mesentery are difficult to access with traditional techniques. Here we describe a case series of laparoscopic infracolic necrosectomy (ICN) and open or laparoscopic infracolic necrosectomy with Roux-en Y cystjejunostomy (ICN-RYCJ) for the management of complicated SAP. MATERIALS AND METHODS: A retrospective analysis of a prospectively maintained database identified all patients treated with infracolic necrosectomy or drainage of pancreatic collections for complicated SAP between 2012 and 2021 inclusive at a single institution...

BACKGROUND: Necrotizing pancreatitis (NP) may result de novo or following procedures such as ERCP or partial pancreatectomy (post-procedural), and may require surgical debridement. Video-assisted retroperitoneal debridement (VARD) is a standard approach for NP that employs a 5 cm incision with varying degrees of blind and open debridement. We describe our technique and outcomes of a modified VARD called laparoscopic-assisted pancreatic necrosectomy (LAPN) performed through a single 12 mm incision that uses direct laparoscopic visualization during debridement...

Mini-invasive surgical or endoscopic step-up approach is the first choice of pancreatic necrosectomy for infected wall-off necrosis. Surgical debridement has the advantage of high efficiency,low cost and good accessibility,while the complication rate of pancreatic fistula and incision hernia after endoscopic necrosectomy is low.Laparoscopic transgastric necrosectomy(LTGN) can combine the advantages of surgical and endoscopic debridement,and may become one of the important methods for the surgical treatment of necrotizing pancreatitis in the future...

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...

No abstract text is available yet for this article.

BACKGROUND: Laparoscopic transgastric necrosectomy (LTGN) has been used in treatment of walled-off pancreatic necrosis (WON) for more than a decade. However, the safety and effectiveness of LTGN for WON with sinistral portal hypertension was still unclear. METHODS: WON patients with sinistral portal hypertension treated in our department between January 2011 and December 2018 were included and retrospectively analyzed in this study. Patients were divided into two groups according to different surgical approaches, LTNG or laparoscopic assisted trans-lesser sac necrosectomy (LATLSN)...

Cholelithiasis is a common gastrointestinal pathology with a prevalence of over 6% in the USA. Symptomatic patients can develop cholangitis, biliary colic, pancreatitis and cholecystitis. Surgical management involves laparoscopic or open cholecystectomy. Stones within the common bile duct can be treated with endoscopic retrograde cholangiopancreatography (ERCP). Well-known ERCP complications include pancreatitis, perforation, bleeding and cholangitis. Hepatic hematomas as a complication of ERCP are extremely rare, with fewer than 50 reported cases in the literature...

Introduction: Free peritoneal perforation of pancreatic fluid collections is extremely rare and only few case reports exist in the literature. Many of these patients undergo emergency exploratory laparotomy due to sepsis and haemodynamic instability requiring sepsis control. The use of laparoscopic techniques in this circumstance is limited by the haemodynamic stability of the patient and the technical challenges. But effective laparoscopic management is associated with less morbidity to the patient...

Background Walled-off pancreatic necrosis (WOPN) represents an encapsulated collection of necrotic pancreatic or peripancreatic tissue that tends to develop four weeks after the onset of acute necrotizing pancreatitis. When infected, it is managed initially by antibiotic therapy before drainage by endoscopic, percutaneous, or surgical means. This study aims to describe the morbidity, mortality, length of stay (LOS), and cost of care associated with open surgical, laparoscopic, and radiology-guided percutaneous drainage in adult patients with infected WOPN...

Pancreatic pseudocyst (PP) is a known complication of pancreatitis. When a rupture occurs, patients often become haemodynamically unstable and require emergency surgery for source control. Conventionally, such a procedure is carried out through open technique due to patient, surgeon and technical factors. We present two cases of emergency laparoscopic surgery performed for ruptured PP. Our first patient was a 53-year-old male with a ruptured 17.6 cm pancreatic body pseudocyst who underwent a laparoscopic washout, adhesiolysis, necrosectomy, distal pancreatectosplenectomy and cholecystectomy...