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The effect of a novel minimally invasive strategy for infected necrotizing pancreatitis. Surg Endosc 2017; 31:4603-4616. [DOI: 10.1007/s00464-017-5522-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 03/15/2017] [Indexed: 12/19/2022]
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Abstract
Background. Video-assisted retroperitoneal necrosectomy is a minimally invasive surgical technique for the treatment of severe acute pancreatitis. This study evaluated the safety and feasibility of a modified single-stage video-assisted retroperitoneal necrosectomy, retroperitoneoscopic anatomical necrosectomy (REAN). Methods. Between September 2010 and May 2012, a total of 17 patients with infected necrotizing pancreatitis underwent REAN. The surgical procedures were similar to retroperitoneoscopic pancreatectomy, in which 3 trocars are utilized. Briefly, the perirenal space was entered through the posterior pararenal space. Dissection proceeded from posterior to anterior direction to expose the dorsal side of the perirenal fascia. This was opened to reach the anterior perirenal space, where the peripancreatic abscess was located. Necrotic tissue was then debrided and catheter drainage was performed in a single stage. Results. Operating time ranged from 45 to 100 minutes with minimal blood loss. All patients recovered except for one who died. Major perisurgical complications included peritoneal injury (1 patient), splenic vein injury (1 patient), retroperitoneal infection with paralytic ileus (1 patient), hydrothorax and atelectasis (2 patients), and subcutaneous cellulitis beneath the incision (3 patients). Two patients required additional percutaneous catheter drainage, and 1 patient required a laparotomy to debride the remaining necrotic tissue. Postoperative hospital stay ranged from 21 to 64 days. Conclusions. This study demonstrates that REAN, a modified single-stage video-assisted retroperitoneal approach, was safe and feasible for the treatment of infected necrotizing pancreatitis. The advantages of this procedure include direct access with shorter operating time, complete necrotic tissue debridement, easy hemostasis, simple manipulation, and easy drainage.
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Affiliation(s)
- Guodong Zhao
- Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Minggen Hu
- Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Rong Liu
- Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
| | - Yong Xu
- The 1st Affiliated Hospital of Chinese People’s Liberation Army (PLA) General Hospital, Beijing, China
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Rohan Jeyarajah D, Osman HG, Patel S. Advances in management of pancreatic necrosis. Curr Probl Surg 2014; 51:374-408. [DOI: 10.1067/j.cpsurg.2014.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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