TY - JOUR

T1 - Simultaneous endoscopic and video-assisted retroperitoneal debridement in walled-off pancreatic necrosis using a laparoscopic access platform

T2 - Two case reports

AU - Lindgaard, Lars

AU - Lauritsen, Morten Laksáfoss

AU - Novovic, Srdan

AU - Hansen, Erik Feldager

AU - Karstensen, John Gásdal

AU - Schmidt, Palle Nordblad

N1 - Publisher Copyright: © The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.

PY - 2022

Y1 - 2022

N2 - BACKGROUND Infected walled-off necrosis is a potentially life-threatening complication of necrotizing pancreatitis. While some patients can be treated by drainage alone, many patients also need evacuation of the infected debris. Central necroses in relation to the pancreatic bed are easily reached via an endoscopic transluminal approach, whereas necroses that involve the paracolic gutters and the pelvis are most efficiently treated via a percutaneous approach. Large and complex necroses may need a combination of the two methods. CASE SUMMARY Transluminal and percutaneous drainage followed by simultaneous endoscopic and modified video-assisted retroperitoneal debridement was carried out in two patients with very large (32-38 cm), infected walled-off necroses using a laparoscopic access platform. After 34 d and 86 d and a total of 9 and 14 procedures, respectively, complete regression of the walled-off necroses was achieved. The laparoscopic access platform improved both access to the cavities as well as the overview. Simultaneous transluminal and percutaneous necrosectomy are feasible with the laparoscopic access platform serving as a useful adjunctive. CONCLUSION This approach may be necessary to control infection and achieve regression in some patients with complex collections.

AB - BACKGROUND Infected walled-off necrosis is a potentially life-threatening complication of necrotizing pancreatitis. While some patients can be treated by drainage alone, many patients also need evacuation of the infected debris. Central necroses in relation to the pancreatic bed are easily reached via an endoscopic transluminal approach, whereas necroses that involve the paracolic gutters and the pelvis are most efficiently treated via a percutaneous approach. Large and complex necroses may need a combination of the two methods. CASE SUMMARY Transluminal and percutaneous drainage followed by simultaneous endoscopic and modified video-assisted retroperitoneal debridement was carried out in two patients with very large (32-38 cm), infected walled-off necroses using a laparoscopic access platform. After 34 d and 86 d and a total of 9 and 14 procedures, respectively, complete regression of the walled-off necroses was achieved. The laparoscopic access platform improved both access to the cavities as well as the overview. Simultaneous transluminal and percutaneous necrosectomy are feasible with the laparoscopic access platform serving as a useful adjunctive. CONCLUSION This approach may be necessary to control infection and achieve regression in some patients with complex collections.

KW - Acute necrotizing pancreatitis

KW - Case report

KW - Minimally invasive surgical procedures

KW - Multiple organ failure

KW - Natural orifice transluminal endoscopy

KW - Sepsis

KW - Walled-off necroses

U2 - 10.3748/wjg.v28.i5.588

DO - 10.3748/wjg.v28.i5.588

M3 - Journal article

C2 - 35316956

AN - SCOPUS:85123873505

VL - 28

SP - 588

EP - 593

JO - World Chinese Journal of Digestology

JF - World Chinese Journal of Digestology

SN - 1009-3079

IS - 5

ER -