Surgical Endoscopy

, Volume 27, Issue 2, pp 443–453

Management of infected pancreatic necrosis using retroperitoneal necrosectomy with flexible endoscope: 10 years of experience

  • Gregorio Castellanos
  • Antonio Piñero
  • Laura A. Doig
  • Andrés Serrano
  • Matilde Fuster
  • Vicente Bixquert
Article

DOI: 10.1007/s00464-012-2455-5

Cite this article as:
Castellanos, G., Piñero, A., Doig, L.A. et al. Surg Endosc (2013) 27: 443. doi:10.1007/s00464-012-2455-5

Abstract

Background

This study was designed to provide our experience in the management of infected and drained pancreatic necrosis using the retroperitoneal approach.

Methods

This was a prospective observational study in a tertiary care university hospital. Thirty-two patients with confirmed infected pancreatic necrosis were studied. Superficial necrosectomy was performed with lavage and aspiration of debris. This was achieved though a retroperitoneal approach of the pancreatic area and under the direct vision of a flexible endoscope. The follow-up procedure using retroperitoneal endoscopy did not require taking the patient to the operating room. The main outcome measures were infection control, morbidity, and mortality related to technique, reintervention, and long-term follow-up.

Results

No significant morbidity or mortality related to the technique was observed in all of the patients with infected pancreatic necrosis treated with this retroperitoneal approach compared with published data using other approaches. Reinterventions were not required and patients are currently asymptomatic.

Conclusions

Retroperitoneal access of the pancreatic area is a good approach for drainage and debridement of infected pancreatic necrosis. Translumbar retroperitoneal endoscopy allows exploration under direct visual guidance avoiding open transabdominal reintervention and the risk of contamination of the abdominal cavity. This technique does not increase morbidity and mortality, can be performed at the patients’ bedside as many times as necessary, and has advantages over other retroperitoneal approaches.

Keywords

Pancreatic Instruments Surgical Technical Endoscopy 

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Gregorio Castellanos
    • 1
  • Antonio Piñero
    • 1
  • Laura A. Doig
    • 2
  • Andrés Serrano
    • 3
  • Matilde Fuster
    • 4
  • Vicente Bixquert
    • 5
  1. 1.Department of General SurgeryVirgen de la Arrixaca University HospitalMurciaSpain
  2. 2.Endoscopic Nurse Specialist formerly of Guy’s and St. Thomas, NHS TrustLondonUK
  3. 3.Endoscopy UnitVirgen de la Arrixaca University HospitalMurciaSpain
  4. 4.Radiodiagnostic DepartmentVirgen de la Arrixaca University HospitalMurciaSpain
  5. 5.Intensive Care UnitVirgen de la Arrixaca University HospitalMurciaSpain

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