A technique for laparoscopic-assisted percutaneous drainage of infected pancreatic necrosis and pancreatic abscess.
Surg Endosc
; 15(10): 1221-5, 2001 Oct.
Article
en En
| MEDLINE
| ID: mdl-11727105
ABSTRACT
BACKGROUND:
Percutaneous drainage has been shown to be an acceptable method for treating both pancreatic abscesses and infected pancreatic necrosis. However, percutaneous techniques have certain shortcomings, including the time and labor required and failure of the catheters to adequately drain the particulate debris. Growing experience around the world indicates that there is a role for retroperitoneal laparoscopy as a means of facilitating the percutaneous drainage of infected pancreatic fluid collections and avoiding a laparotomy. Our technique is discussed in this paper.METHODS:
Once infection is documented in a pancreatic fluid collection by fine-needle aspiration, one or more percutaneous drains are placed into the fluid collection(s). A computed tomography (CT) scan is repeated. If further drainage is indicated, retroperitoneoscopic debridement is performed. Using a combination of the percutaneous drain(s) and the post-drain CT scan, ports are placed and retroperitoneoscopic debridement of the necrosectum is performed under direct visualization. Prior to completion of the operation, a postoperative lavage system is created.RESULTS:
Six patients with infected pancreatic necrosis have been treated with this technique. Prior to commencement of our laparoscopic protocol, all six patients would have required open necrosectomy. Four of the six patients were managed with retroperitoneoscopic debridement and catheter drainage alone. Complications included a colocutaneous fistula and a small flank hernia. There were no bleeding complications and no deaths.CONCLUSION:
Although open necrosectomy remains the standard of care for the treatment of infected pancreatic necrosis and pancreatic abscess, there is growing evidence that laparoscopic retroperitoneal debridement is feasible.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Enfermedades Pancreáticas
/
Drenaje
/
Laparoscopía
/
Absceso Abdominal
/
Pancreatitis Aguda Necrotizante
/
Desbridamiento
Tipo de estudio:
Guideline
Límite:
Humans
Idioma:
En
Revista:
Surg Endosc
Asunto de la revista:
DIAGNOSTICO POR IMAGEM
/
GASTROENTEROLOGIA
Año:
2001
Tipo del documento:
Article
País de afiliación:
Estados Unidos