Brent D Bauman, MD, Victor Vakayil, MBBS, Steuart Amateau, MD, Malavika Chandrashekar, BS, Martin Freeman, MD, James V Harmon, MD, PhD. University of Minnesota
Introduction: Acute pancreatitis affects over 280,000 patients annually in the United States and carries high morbidity and mortality. Up to 20% of patients will develop necrotizing pancreatitis. Mortality is highest in patients who develop infection of the necrotic pancreatic tissue. Open necrosectomy is the traditional approach to management of these patients. More recently, minimally invasive techniques have been developed to avoid the morbidity of open necrosectomy including percutaneous, endoscopic, and video assisted retroperitoneal debridment (VARD). We present our own recent experience in managing acute necrotizing pancreatitis through VARD.
Methodology: We present a single midwestern institutional experience in the management of acute necrotizing pancreatitis.
Results: Over a seven-year period there were 320 admissions for acute necrotizing pancreatitis. There were eight patients whom ultimately underwent VARD. We managed cases of acute necrotizing pancreatitis in a step-wise process. Initially, a percutaneous retroperitoneal drain was placed. Next, we used the percutaneous drain tract as a guide for placement of a trocar for balloon inflation of the retroperitoneal space and creation of a second retroperitoneal space through which the necrotic pancreatic tissue was debrided. The axiom chest tubes were then placed in the trocar sites for drainage. There was a single mortality in the VARD group for a mortality of 12.5. We found that the VARD procedure led to decreased use of open pancreatic necrosectomy and decreased hospital stay.
Discussion: Video assisted retroperitoneal debridement has demonstrated decreased morbidity and mortality compared to the traditional open approach. Our series demonstrate the significant morbidity and prolonged hospital stays associated with infected pancreatic necrosis. Our series also demonstrates that even though a step-wise progression from percutaneous drainage to VARD procedure, an open drainage procedure may still be required. Furthermore, a comparison of our VARD cases show how an open drainage procedure is associated with a longer hospital stay and the morbidity of multiple open washouts and delayed abdominal closure.
Conclusion: Infected pancreatic necrosis should ideally be treated through a step-wise approach using minimally invasive techniques. The VARD procedure may lead to decreased hospital stay, decreased morbidity and improved mortality.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80487
Program Number: P453
Presentation Session: Poster (Non CME)
Presentation Type: Poster
