Login to MyKarger

New to MyKarger? Click here to sign up.

Login with Facebook

Forgot Password? Reset your password

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login (Shibboleth)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Table of Contents
Vol. 29, No. 6, 2012
Issue release date: April 2013
Section title: How I Do It
Dig Surg 2012;29:475–476
(DOI:10.1159/000345620)

How Do We Apply Video-Assisted Retroperitoneal Necrosectomy with Minimal Access?

Wenning A.S.a · Angst E.a · Lechleiter A.a · Brugger J.-J.b · Candinas D.a · Gloor B.a
aDepartment of Visceral Surgery and Medicine, Inselspital, University of Bern, Bern, and bDepartment of Surgery, Hôpital Pourtalès, Neuchâtel, Switzerland
email Corresponding Author

Eliane Angst

BHH D120

Department of Visceral Surgery and Medicine, Inselspital

CH–3010 Bern (Switzerland)

E-Mail eliane.angst@gmail.com


Abstract

Background: The conservative treatment of acute necrotizing pancreatitis has greatly improved due to broad antibiotic treatment and improved organ support in intensive care units. Nevertheless, infected necrosis or persistent multi-organ dysfunction are predictors of poor outcome. In these patients, there is still a need to perform necrosectomy. Open surgery results in extensive operative trauma and is associated with high morbidity and mortality. Therefore, several minimally invasive techniques have been developed recently. Retroperitoneal necrosectomy has been shown to be safe and to reduce morbidity and mortality compared to the open procedure. Methods and Results: In an instructive video, we show the technique of video-assisted retroperitoneal necrosectomy with minimal access, including the preoperative percutaneous drainage and several accesses to the necrosis. We discuss the indication for retroperitoneal necrosectomy as well as the optimal time point of the intervention. Conclusion: In the management of acute necrotizing pancreatitis, the multidisciplinary approach is crucial. The initial treatment by the intensive care units should be extended to intervention or surgery in case of infected necrosis or persistent multi-organ dysfunction. We show here a minimal access solution with the placement of a percutaneous drain followed by video-assisted retroperitoneal necrosectomy.

© 2013 S. Karger AG, Basel


Related Articles for ""

Close Related Articles


The video showing the technique of video-assisted retroperitoneal necrosectomy can be accessed via the following link: www.karger.com?doi=10.1159/000345620.

Acknowledgements

We thank Gianni Pauciello for the excellent technical production and Trevor John Roling for the dubbing of the video.

Disclosure Statement

None.


References

  1. Buchler MW, Gloor B, Muller CA, Friess H, Seiler CA, Uhl W: Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg 2000;232:619–626.
  2. Besselink MG: The ‘step-up approach’ to infected necrotizing pancreatitis: delay, drain, debride. Dig Liver Dis 2011;43:421–422.
  3. Uhl W, Warshaw A, Imrie C, Bassi C, McKay CJ, Lankisch PG, Carter R, Di Magno E, Banks PA, Whitcomb DC, Dervenis C, Ulrich CD, Satake K, Ghaneh P, Hartwig W, Werner J, McEntee G, Neoptolemos JP, Buchler MW: IAP guidelines for the surgical management of acute pancreatitis. Pancreatology 2002;2:565–573.
  4. Hungness ES, Robb BW, Seeskin C, Hasselgren PO, Luchette FA: Early debridement for necrotizing pancreatitis: is it worthwhile? J Am Coll Surg 2002;194:740–744, discussion 744–745.
  5. Mier J, Leon EL, Castillo A, Robledo F, Blanco R: Early versus late necrosectomy in severe necrotizing pancreatitis. Am J Surg 1997;173:71–75.
  6. UK guidelines for the management of acute pancreatitis. Gut 2005;54(suppl 3):iii1–iii9.
  7. van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, van Goor H, Schaapherder AF, van Eijck CH, Bollen TL, van Ramshorst B, Nieuwenhuijs VB, Timmer R, Lameris JS, Kruyt PM, Manusama ER, van der Harst E, van der Schelling GP, Karsten T, Hesselink EJ, van Laarhoven CJ, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, van Leeuwen MS, Buskens E, Gooszen HG: A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010;362:1491–1502.
  8. Horvath KD, Kao LS, Wherry KL, Pellegrini CA, Sinanan MN: A technique for laparoscopic-assisted percutaneous drainage of infected pancreatic necrosis and pancreatic abscess. Surg Endosc 2001;15:1221–1225.
  9. van Baal MC, van Santvoort HC, Bollen TL, Bakker OJ, Besselink MG, Gooszen HG: Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis. Br J Surg 2011;98:18–27.

Author Contacts

Eliane Angst

BHH D120

Department of Visceral Surgery and Medicine, Inselspital

CH–3010 Bern (Switzerland)

E-Mail eliane.angst@gmail.com


Article / Publication Details

First-Page Preview
Abstract of How I Do It

Published online: January 16, 2013
Issue release date: April 2013

Number of Print Pages: 2
Number of Figures: 0
Number of Tables: 0

ISSN: 0253-4886 (Print)
eISSN: 1421-9883 (Online)

For additional information: http://www.karger.com/DSU


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Buchler MW, Gloor B, Muller CA, Friess H, Seiler CA, Uhl W: Acute necrotizing pancreatitis: treatment strategy according to the status of infection. Ann Surg 2000;232:619–626.
  2. Besselink MG: The ‘step-up approach’ to infected necrotizing pancreatitis: delay, drain, debride. Dig Liver Dis 2011;43:421–422.
  3. Uhl W, Warshaw A, Imrie C, Bassi C, McKay CJ, Lankisch PG, Carter R, Di Magno E, Banks PA, Whitcomb DC, Dervenis C, Ulrich CD, Satake K, Ghaneh P, Hartwig W, Werner J, McEntee G, Neoptolemos JP, Buchler MW: IAP guidelines for the surgical management of acute pancreatitis. Pancreatology 2002;2:565–573.
  4. Hungness ES, Robb BW, Seeskin C, Hasselgren PO, Luchette FA: Early debridement for necrotizing pancreatitis: is it worthwhile? J Am Coll Surg 2002;194:740–744, discussion 744–745.
  5. Mier J, Leon EL, Castillo A, Robledo F, Blanco R: Early versus late necrosectomy in severe necrotizing pancreatitis. Am J Surg 1997;173:71–75.
  6. UK guidelines for the management of acute pancreatitis. Gut 2005;54(suppl 3):iii1–iii9.
  7. van Santvoort HC, Besselink MG, Bakker OJ, Hofker HS, Boermeester MA, Dejong CH, van Goor H, Schaapherder AF, van Eijck CH, Bollen TL, van Ramshorst B, Nieuwenhuijs VB, Timmer R, Lameris JS, Kruyt PM, Manusama ER, van der Harst E, van der Schelling GP, Karsten T, Hesselink EJ, van Laarhoven CJ, Rosman C, Bosscha K, de Wit RJ, Houdijk AP, van Leeuwen MS, Buskens E, Gooszen HG: A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med 2010;362:1491–1502.
  8. Horvath KD, Kao LS, Wherry KL, Pellegrini CA, Sinanan MN: A technique for laparoscopic-assisted percutaneous drainage of infected pancreatic necrosis and pancreatic abscess. Surg Endosc 2001;15:1221–1225.
  9. van Baal MC, van Santvoort HC, Bollen TL, Bakker OJ, Besselink MG, Gooszen HG: Systematic review of percutaneous catheter drainage as primary treatment for necrotizing pancreatitis. Br J Surg 2011;98:18–27.