Laparoscopic Necrosectomy for Treating Infected Necrotizing Pancreatitis

Yoon, Yoo Seok; Han, Ho Seong; Shin, Sang Hyun; Cho, Jai Young; Quan, Jiang Chang; Jang, Jin Young; Kim, Sun Whe

Abstract

Infected pancreatic necrosis is generally considered as an indication for surgical management, and this condition has traditionally been treated by laparotomy. However, open surgery still has high morbidity and mortality rates. The application of minimally invasive surgery to this disease entity has been recently tried with the possibility of incurring less morbidity. Herein we report on two cases of successful laparoscopic necrosectomy for treating infected pancreatic necrosis. Two patients developed acute necrotizing pancreatitis that involved the neck, body and tail of the pancreas after heavy drinking. Initially, percutanous drainage (PCD) was performed for these lesions. However, surgical debridement was decided on due to the patients' non-responsiveness to medical treatment and infection was documented in the drainage fluid. Laparoscopic necrosectomy was performed using 5 trocars. The transmesocolic approach was adopted for the lesion around the pancreas body and tail, and the transgastrocolic approach was used for the lesion around the pancreas neck. The operation time was 190 and 225 minutes, respectively. There was no mortality. Although a pancreatic fistula occurred in one patient, it was improved by conservative management. Our cases show the technical feasibility and effectiveness of laparoscopic necrosectomy, but more experience is needed for this procedure to become a useful treatment option for infected pancreatic necrosis.