Retroperitoneal Laparoscopy for Pancreatic Necrosis

Objective To study the feasibility and efficacy of retroperitoneal laparoscopy for debridement in patients with infected pancreatic necrosis or non-resolving sterile necrotizing pancreatitis. Methods All patients with necrotizing pancreatitis detected on contrast enhanced computed tomography admitted in the Department of Gastroenterology and GI Surgery in AIIMS new Delhi from March 2011-June 2012 were included in this study. Patients with infected pancreatic necrosis or extensive non-resolving sterile pancreatic necrosis safely accessible through a left retroperitoneal approach were included for retroperitoneal laparoscopic debridement and a percutaneous drain in the peripancreatic collection was placed under ultrasound guidance preoperatively. Postoperatively the cavity was irrigated with isotonic saline and drained through two 32 French tube drains placed in the cavity during surgery. Results Ten patients underwent retroperitoneal laparoscopy out of 129 patients with necrotizing pancreatitis. Various complications of necrotizing pancreatitis included ileus, seizures, metabolic encephalopathy, sepsis, pleural effusion and chest infection. The median preoperative duration of illness was 38 days (34-70 days). The median operative time was 2 hours and the mean blood loss was 425 ml (100-1700 ml). The median values of postoperative clinical parameters like oral intake, mobility, number of days of antibiotic continuity, postoperative hospital stay, drain removal and wound healing were 4, 5, 30, 31, 72 and 87 days respectively. Three patients died. Conclusion Retroperitoneal laparoscopic debridement is feasible in about one-third of patients with acute necrotizing pancreatitis requiring necrosectomy with an acceptable operating time, blood loss, conversion to open, post operative morbidity and mortality.