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Translumbar Retroperitoneal Endoscopy
An Alternative in the Follow-up and Management of Drained Infected Pancreatic Necrosis
Gregorio Castellanos, MD, PhD;
Antonio Piñero, MD, PhD;
Andrés Serrano, MD;
Cristina Llamas, MD;
Matilde Fuster, MD;
Juan Angel Fernandez, MD;
Pascual Parrilla, MD, PhD
Arch Surg. 2005;140:952-955.
Background The follow-up of drained infected pancreatic necrosis (IPN) is usually done with data on the patient’s clinical evolution and information obtained from serial helical computed tomographic scans. Management often requires necrosectomies and periodic debridements.
Hypothesis Translumbar retroperitoneal endoscopy is effective in the management of drained IPN.
Design A prospective observational study.
Setting University tertiary care hospital.
Patients A series of 11 consecutive patients with drained IPN undergoing postoperative follow-up with translumbar retroperitoneal endoscopy.
Interventions Initially, the IPN was drained via the posterior extraperitoneal translumbar approach; then, a superficial necrosectomy was performed during the same surgical intervention by flushing and endoscopic aspiration; and, finally, a lavage and drainage system was fitted. In the immediate postoperative period, for management of the IPN, we removed the drainage tube and inserted a flexible endoscope as far as the pancreatic area to eliminate the infected necrotic material by flushing and aspiration.
Main Outcome Measures In these patients, we studied control of the infection of the pancreatic area, quantification variables of the necrosectomy, technique-related morbidity and mortality, and the need for subsequent operations.
Results The 11 patients studied showed good results regarding the control and complete elimination of the infected necrosis. There was no technique-related morbidity or mortality or need for subsequent operations.
Conclusion Translumbar retroperitoneal endoscopy allows exploration of the retroperitoneal space under direct visual guidance, facilitates lavage and aspiration, avoids subsequent surgical operations for debridement, decreases the need for repeated computed tomographic scans to evaluate the evolution of the IPN, and has no added morbidity or mortality.
Author Affiliations: Departments of General Surgery (Drs Castellanos, Piñero, Fernandez, and Parrilla) and Radiology (Dr Fuster), Endoscopy Unit (Dr Serrano), and Intensive Care Unit (Dr Llamas), Virgen de la Arrixaca University Hospital, Murcia, Spain.
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