Journal of the American College of Surgeons
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Two-Port Minimally Invasive Nephro-Laparoscopic Retroperitoneal Debridement for Pancreatic Necrosis.
Walled-off necrosis (WON) occurs in approximately 20% of patients with necrotizing pancreatitis. Infection occurs in approximately 30% of necrosis patients, and despite advances in management, infected necrosis still confers a high mortality between 30 and 40%. While sterile necrosis requires drainage only for cases of symptom relief or "persistent unwellness," prompt intervention is critical for infected necrosis. ⋯ These debridement techniques include video-assisted retroperitoneal debridement (VARD) through a flank incision or minimally invasive retroperitoneal pancreatic (MIRP) necrosectomy under continuous irrigation with a nephroscope. While effective, both debridement strategies have drawbacks: for VARD, the flank incision is prone to infections and hernia while MIRP debridements are tedious and often require repeat operative trips. To overcome these pitfalls, we describe a novel two-trocar minimally invasive hybrid nephro-laparoscopic retroperitoneal debridement technique for an efficient retroperitoneal pancreatic necrosectomy.