This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on ISI (8)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Liver/ Biliary Tract/ Pancreatic Diseases  • Endocrine Surgery  • Endoscopy/ Minimally Invasive Surgery  • Hepatobiliary Surgery  • Alert me on articles by topic

A New Surgical Option for Treatment of Severe Necrotizing Pancreatitis

Dilip Parekh, MD

Arch Surg. 2006;141:895-903.

Hypothesis  Open surgery for pancreatic debridement is often associated with major morbidity such as wound complications, fascial dehiscence, and intestinal fistulae. Hand-assisted laparoscopic surgery (HALS) is useful for complex abdominal procedures since the benefits of traditional laparoscopic surgery are retained. Published experience with HALS for pancreatic debridement is limited to anecdotal case reports.

Setting  University-affiliated private and public hospitals.

Patients  Twenty-three patients with necrotizing pancreatitis were evaluated and 19 patients underwent pancreatic debridement from 2001 to 2006. A GelPort (Applied Medical, Rancho Santa Margarita, Calif) was used to provide laparoscopic hand access. In the majority of the patients, an infracolic approach was used to access the pancreatic necrosis.

Results  Nineteen patients underwent laparoscopic evacuation of pancreatic necrosis, and in 18 patients, the procedure was completed. The mean age was 54 years; the mean ± SEM body mass index, calculated as weight in kilograms divided by height in meters squared, was 32.0 ± 2.6; the mean American Society of Anesthesiologists score was 3.4; and 7 of 19 patients had past history organ failure. The mean ± SEM operating time was 153 ± 10 minutes and mean ± SEM blood loss was 352.6 ± 103 mL. Four patients required reoperations, 2 using HALS and 2 open. There were no postoperative complications related to the HAL procedure itself, such as major wound infections, intestinal fistulae, or postoperative hemorrhage. Postoperative computed tomographic scans confirmed adequacy of debridement. The mean ± SEM length of hospital stay after surgery was 16.3 ± 3.8 days.

Conclusions  This is the largest reported study of laparoscopic debridement for pancreatic necrosis. The procedure is feasible and associated with a low morbidity and mortality. Pancreatic debridement with HALS may provide a new option for the surgical treatment of selected patients with severe necrotizing pancreatitis.

Author Affiliation: Department of Surgery, University of Southern California, Los Angeles.