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Surgical Endoscopy

, Volume 30, Issue 3, pp 1235–1241 | Cite as

Laparoscopy-assisted open cystogastrostomy and pancreatic debridement for necrotizing pancreatitis (with video)

  • Olivier Gerin
  • Flavien Prevot
  • Abdennaceur Dhahri
  • Sami Hakim
  • Richard Delcenserie
  • Lionel Rebibo
  • Jean-Marc RegimbeauEmail author
Dynamic Manuscript

Abstract

Introduction

Pancreatic pseudocysts and walled-off necrosis are well-known complications, described in 10 % of cases of acute pancreatitis. Open cystogastrostomy is usually proposed after failure of minimally invasive drainage or in the presence of septic shock. The objective of this study was to evaluate the feasibility and efficacy of laparoscopy-assisted open cystogastrostomy for treatment of symptomatic pancreatic pseudocyst with pancreatic necrosis.

Materials and methods

Between January 2011 and October 2014, all patients with pseudocyst and pancreatic necrosis undergoing open cystogastrostomy were included. Surgical procedure was standardized. The primary efficacy endpoint was the feasibility and efficacy of laparoscopy-assisted open cystogastrostomy as treatment of symptomatic pancreatic pseudocyst. Secondary endpoints included demographic data, preoperative management, operative data, postoperative data and follow-up.

Results

Laparoscopy-assisted open cystogastrostomy was performed in 11 patients [six men (54 %)], with a median age of 61 years (45–84). Nine patients received preoperative radiological or endoscopic management. First-line open cystogastrostomy was performed in two cases. Median operating time was 190 min (110–240). There was one intraoperative complication related to injury of a branch of the superior mesenteric vein. There were no postoperative deaths and two postoperative complications (18 %) including one major complication (postoperative bleeding). The median length of hospital stay after surgery was 16 days (7–35). The median follow-up was 10 months (2–45). One patient experienced recurrence during follow-up.

Conclusion

Open cystogastrostomy for necrotizing pancreatitis promotes adequate internal drainage with few postoperative complications and a short length of hospital stay. However, this technique must be performed very cautiously due to the risk of vascular injury which can be difficult to repair in the context of severe local inflammation related to pancreatic necrosis.

Keywords

Pancreatic necrosis Pancreatic pseudocyst Open cystogastrostomy Laparoscopy-assisted 

Notes

Compliance with Ethical Standards

Disclosures

Olivier Gerin, Flavien Prevot, Abdennaceur Dhahri, Richard Delcenserie, Lionel Rebibo and Jean-Marc Regimbeau have no conflicts of interest or financial ties to disclose.

Supplementary material

Supplementary material 1 (MPG 23338 kb)

Supplementary material 2 (MPG 23258 kb)

Supplementary material 3 (MPG 24528 kb)

Supplementary material 4 (MPG 16104 kb)

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Olivier Gerin
    • 1
  • Flavien Prevot
    • 1
  • Abdennaceur Dhahri
    • 1
  • Sami Hakim
    • 2
  • Richard Delcenserie
    • 2
  • Lionel Rebibo
    • 1
  • Jean-Marc Regimbeau
    • 1
    • 3
    • 4
    Email author
  1. 1.Department of Digestive Surgery, Hôpital SudAmiens University HospitalAmiens Cedex 01France
  2. 2.Department of GastroenterologyAmiens University HospitalAmiens Cedex 01France
  3. 3.EA4294Jules Verne University of PicardieAmiens Cedex 01France
  4. 4.Clinical Research CenterAmiens University HospitalAmiens Cedex 01France

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