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Laparoscopic necrosectomy

W A E Udeshika, H M M T B Herath, S U B Dassanayake, S P Pahalagamage, Aruna Kulatunga
BACKGROUND: Pancreatic cysts are being diagnosed more frequently because of the increasing usage of imaging techniques. A pseudocyst with the major diameter of 10 cm is termed as a giant cyst. Asymptomatic pseudo-cysts up to 6 cm in diameter can be safely observed and monitored without intervention, but larger and symptomatic pseudocysts require intervention. CASE PRESENTATION: A 27-year-old Sri Lankan male, with history of heavy alcohol use, presented with progressive abdominal distension following an episode of acute pancreatitis...
April 27, 2018: BMC Research Notes
Monica M Dua, David J Worhunsky, Lavina Malhotra, Walter G Park, George A Poultsides, Jeffrey A Norton, Brendan C Visser
BACKGROUND: The best operative strategy for necrotizing pancreatitis remains controversial. Traditional surgical necrosectomy is associated with significant morbidity; endoscopic and percutaneous strategies require repeated interventions with prolonged hospitalizations. We have developed a transgastric approach to pancreatic necrosectomy to overcome the shortcomings of the other techniques described. MATERIALS AND METHODS: Patients with necrotizing pancreatitis treated from 2009 to 2016 at an academic center were retrospectively reviewed...
November 2017: Journal of Surgical Research
Deeplaxmi Purushottam Borle, Nikhil Agrawal, Asit Arora, Senthil Kumar, Tushar Kanti Chattopadhyay
INTRODUCTION: Gallstones are an etiological factor in 23%-54% of patients with acute pancreatitis. A small proportion of these patients will also have intestinal complications requiring necrosectomy with diverting loop ileostomy. Later, these patients require cholecystectomy and ileostomy reversal. Laparoscopic cholecystectomy is fraught with difficulty in these patients due to dense intra-abdominal adhesions, and many surgeons resort to an open approach. We describe a technique which takes advantage of the ileostomy site for initial access...
August 1, 2017: Journal of Minimal Access Surgery
G Alsfasser, S Hermeneit, B M Rau, E Klar
Laparoscopic procedures have advanced to represent the new gold standard in many surgical fields. Although application in pancreatic surgery is hampered by the friable nature of the gland and the difficulty of its exposure, advanced technology and surgeons' experience are leading to an expansion of minimally invasive pancreatic surgery. Addressing the whole range of main operative procedures, this review analyzes the literature data so far to give an overview about the current status of minimally invasive pancreatic surgery, its indications and limitations...
2016: Digestive Surgery
K Vengadakrishnan, A K Koushik
BACKGROUND: Acute pancreatitis is a common disease with wide clinical variation and its incidence is increasing. Acute pancreatitis may vary in severity, from mild self-limiting pancreatic inflammation to pancreatic necrosis with life-threatening sequelae. Severity of acute pancreatitis is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis. AIM AND OBJECTIVES: The present study was aimed to assess the clinical profile of acute pancreatitis and to assess the efficacy of various severity indices in predicting the outcome of patients...
October 2015: International Journal of Health Sciences
Eugene Lim, R S Sundaraamoorthy, David Tan, Hui-Seong Teh, Tzu-Jen Tan, Anton Cheng
INTRODUCTION: Infected Necrotizing Pancreatitis carries a high mortality and necessitates intervention to achieve sepsis control. The surgical strategy for proven infected necrosis has evolved, with abandonment of open necrosectomy to a step-up approach consisting of percutaneous drains and Video-assisted retroperitoneal debridement (VARD). We present a case that underwent VARD complicated by bleeding and colonic perforation and describe its management. PRESENTATION OF CASE: A 38 year-old male with acute pancreatitis developed infected necrotizing pancreatitis...
September 2015: Annals of Medicine and Surgery
Jennifer A Logue, C Ross Carter
Consensus advocating a principle of early organ support, nutritional optimisation, followed ideally by delayed minimally invasive intervention within a "step-up" framework where possible has radically changed the surgical approach to complications of acute pancreatitis in the last 20 years. The 2012 revision of the Atlanta Classification incorporates these changes, and provides a background which underpins the complexities of individual patient management decisions. This paper discusses the place for delayed minimally invasive surgical intervention (percutaneous necrosectomy, video-assisted retroperitoneal debridement (VARD)), and the rationale for opting to adopt a percutaneous approach over endoscopic or laparoscopic approaches in different clinical situations...
2015: Gastroenterology Research and Practice
A B Cresswell, H Nageswaran, A Belgaumkar, R Kumar, N Menezes, A Riga, T R Worthington, N D Karanjia
INTRODUCTION: Despite advances in surgery and critical care, severe pancreatitis continues to be associated with a high rate of mortality, which is increased significantly in the presence of infected pancreatic necrosis. Controversy persists around the optimal treatment for such cases, with specialist units variously advocating open necrosectomy, simple percutaneous drainage or one of several minimal access approaches. We describe our technique and outcomes with a two-port laparoscopic retroperitoneal necrosectomy (2P-LRN)...
July 2015: Annals of the Royal College of Surgeons of England
Mohammad Khreiss, Mazen Zenati, Amber Clifford, Kenneth K Lee, Melissa E Hogg, Adam Slivka, Jennifer Chennat, Andres Gelrud, Herbert J Zeh, Georgios I Papachristou, Amer H Zureikat
INTRODUCTION: Walled-off pancreatic necrosis (WON) is a sequela of acute necrotizing pancreatitis in 15-40% of cases. We sought to compare the outcomes of minimally invasive surgical and endoscopic cyst gastrostomy (CG) and necrosectomy for the management for sterile WON at a tertiary care high-volume pancreas center. METHOD: This is a retrospective review of patients who underwent minimally invasive surgical or endoscopic CG and necrosectomy for clinically sterile WON between 2008 and 2013...
August 2015: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
R Kostka, J Havlůj
INTRODUCTION: Treatment of necrotizing pancreatitis continues to evolve. The standard therapeutic method for infected pancreatic necrosis and its subsequent septic complications is open surgical drainage. The advances in radiological imaging and interventional radiology have enabled the development of minimally invasive procedures, i.e. percutaneous drainage (PCD) under CT/USG control, endoscopic transgastric necrosectomy (ENE), laparoscopic transperitoneal necrosectomy (LNE) and retroperitoneal access to pancreatic necrosis (RENE)...
April 2015: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Rahul Pannala, Andrew S Ross
There has been a paradigm shift in the management of pancreatic necrosis from open surgical debridement of infected necrosis to minimally invasive interventional radiologic, laparoscopic, and endoscopic drainage/debridement techniques. A step-up approach from less invasive to the more invasive modalities is recommended. An important distinction to make is between pseudocysts and walled-off necrosis (WON), as the interventions for each are different. Endoscopic or other interventions should be delayed for at least 4 weeks for collections to encapsulate...
June 2015: Current Treatment Options in Gastroenterology
Hubertus Feussner, Valentin Becker, Margit Bauer, Michael Kranzfelder, Rebekka Schirren, Tim Lüth, Alexander Meining, Dirk Wilhelm
Flexible endoscopy is increasingly developing into a therapeutic instead of a purely diagnostic discipline. Improved visualization makes early lesions easily detectable and allows us to decide ad hoc on the required treatment. Deep enteroscopy allows the exploration of even the small bowel - for long a "white spot" for gastrointestinal endoscopy - and to perform direct treatment. Endoscopic submucosal dissection is a considerable step forward in oncologically correct endoscopic treatment of (early) malignant lesions...
2015: Clinical and Experimental Gastroenterology
Yu-Chung Chang
In 1886, Senn stated that removing necrotic pancreatic and peripancreatic tissue would benefit patients with severe acute pancreatitis. Since then, necrosectomy has been a mainstay of surgical procedures for infected necrotizing pancreatitis (NP). No published report has successfully questioned the role of necrosectomy. Recently, however, increasing evidence shows good outcomes when treating walled-off necrotizing pancreatitis without a necrosectomy. The literature concerning NP published primarily after 2000 was reviewed; it demonstrates the feasibility of a paradigm shift...
December 7, 2014: World Journal of Gastroenterology: WJG
David J Worhunsky, Motaz Qadan, Monica M Dua, Walter G Park, George A Poultsides, Jeffrey A Norton, Brendan C Visser
BACKGROUND: Traditional open necrosectomy for pancreatic necrosis is associated with significant morbidity and mortality. Although minimally invasive techniques have been described and offer some promise, each has considerable limitations. This study assesses the safety and effectiveness of laparoscopic transgastric necrosectomy (LTN), a novel technique for the management of necrotizing pancreatitis. STUDY DESIGN: Between 2009 and 2013, patients with retrogastric pancreatic necrosis requiring debridement were evaluated for LTN...
October 2014: Journal of the American College of Surgeons
Jacek Szeliga, Marek Jackowski
INTRODUCTION: Acute pancreatitis (AP) consists of an extremely varied complex of pathological symptoms and clinical conditions, ranging from mild gastric complaints to multi-organ failure resulting in death. AIM: To present the authors' own experience regarding surgical treatment for pancreatic necrosis complicated by infection using different methods, including classic and laparoscopic methods as well as those combined with percutaneous techniques. MATERIAL AND METHODS: In the period 2007-2010, 34 patients with the diagnosis of severe AP were treated at the Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Nicolaus Copernicus University...
June 2014: Wideochirurgia i Inne Techniki Mało Inwazyjne, Videosurgery and Other Miniinvasive Techniques
Mittu John Mathew, Amit Kumar Parmar, Diwakar Sahu, Prasanna Kumar Reddy
CONTEXT: Pancreatic necrosis is a local complication of acute pancreatitis. The development of secondary infection in pancreatic necrosis is associated with increased mortality. Pancreatic necrosectomy is the mainstay of invasive management. AIMS: Surgical approach has significantly changed in the last several years with the advent of enhanced imaging techniques and minimally invasive surgery. However, there have been only a few case series related to laparoscopic approach, reported in literature to date...
July 2014: Journal of Minimal Access Surgery
Andrew A Gumbs, Roland Croner, Angel Rodriguez, Noah Zuker, Aristoteles Perrakis, Brice Gayet
INTRODUCTION: Because of the potential benefit of robotics in pancreatic surgery, we review our experience at two minimally invasive pancreatic surgery centers that utilize a robotically controlled laparoscope holder to see if smaller robots that enable the operating surgeon to maintain contact with the patient may have a role in the treatment of pancreatic disease. METHODS: From March 1994 to June 2011, a total of 200 laparoscopic pancreatic procedures utilizing a robotically controlled laparoscope holder were performed...
October 2013: Surgical Endoscopy
Peter Keogh, James Wood
Hemifacial flushing developed in a 48-year-old man after he underwent laparoscopic cholecystectomy and pancreatic necrosectomy. After the induction of general anesthesia, a central venous catheter had been inserted into his left internal jugular vein under ultrasonographic guidance, without the use..
January 24, 2013: New England Journal of Medicine
Purnima Kunjathaya, Pradeep Kakkadasam Ramaswami, Anupama Nagar Krishnamurthy, Naresh Bhat
CONTEXT: To report a case of acute necrotizing pancreatitis in a patient receiving vildagliptin. CASE REPORT: A 49-year-old man presented to us with severe abdominal pain and was diagnosed to have pancreatitis three weeks after the commencement of vildagliptin for the treatment of uncontrolled type 2 diabetes mellitus. His serum amylase was 2,215 U/L at admission, with contrast enhanced computed tomography (CECT) of the abdomen and pelvis showing features of acute pancreatitis...
January 2013: JOP: Journal of the Pancreas
Brian Bello, Jeffrey B Matthews
AIM: To systematically review these minimally invasive approaches to infected pancreatic necrosis. METHODS: We used the MEDLINE database to investigate studies between 1996 and 2010 with greater than 10 patients that examined these techniques. Using a combination of Boolean operators, reports were retrieved addressing percutaneous therapy (341 studies), endoscopic necrosectomy (574 studies), laparoscopic necrosectomy via a transperitoneal approach (148 studies), and retroperitoneal necrosectomy (194 studies)...
December 14, 2012: World Journal of Gastroenterology: WJG
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