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Laparoscopic Assisted Retroperitoneal Necrosectomy

Gillian Alex, MD, Sameer Gupta, MD, Benjamin Veenstra. Rush University Medical Center

Necrotizing pancreatitis with superimposed infection is associated with high rates of complication and mortality. Traditional surgical management has been open necrosectomy which is associated with a high morbidity, death rate of 11-39% and a long term risk of pancreatic insufficiency. Since 2010 a step-up approach made well known by van Santvoort out of the Netherlands has become the preferred mode of addressing superinfected necrotizing pancreatitis. The step up approach uses percutaneous drainage to achieve source control without the need for debridement of the necrotic pancreas. While less morbid this process can be timely and still leaves the necrotic pancreas in place.

We present a case of a man who underwent robotic distal pancreatectomy with splenectomy converted to open for a tail pancreatic adenocarcinoma. His surgery was complicated by acute pancreatitis converting to necrotizing pancreatitis with a superimpose infection. He had failed percutaneous drainage and required a solution that would allow him to have complete debridement of the infected necrotic tissue and a quick recovery so that he would be able to start his adjuvant chemotherapy.

We offered him and performed a laparoscopic assisted retroperitoneal necrosectomy via a 6cm posterior incision. He tolerated the procedure well and was able to be discharged home within 1 week of his necrosectomy. We offer this approach as a safe and less morbid technique for the management of infected necrotizing pancreatitis.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 80790

Program Number: V176

Presentation Session: Video Loop

Presentation Type: VideoLoop

40

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