Minimally invasive procedures in severe acute pancreatitis treatment - assessment of benefits and possibilities of use

Jacek Szeliga, Marek Jackowski, Jacek Szeliga, Marek Jackowski

Abstract

Introduction: Acute pancreatitis (AP) consists of an extremely varied complex of pathological symptoms and clinical conditions, ranging from mild gastric complaints to multi-organ failure resulting in death.

Aim: To present the authors' own experience regarding surgical treatment for pancreatic necrosis complicated by infection using different methods, including classic and laparoscopic methods as well as those combined with percutaneous techniques.

Material and methods: In the period 2007-2010, 34 patients with the diagnosis of severe AP were treated at the Department of General, Gastroenterological and Oncological Surgery, Collegium Medicum, Nicolaus Copernicus University. In 7 patients classic necrosectomy with repeated peritoneal flushing was performed (type 1), in 5 patients laparotomy with active drainage (type 2), in 12 video-assisted retroperitoneal debridement (type 3), and in 10 only percutaneous drainage methods (type 4).

Results: Total duration of hospitalisation was from 10 to 192 days. The highest death rate was observed for type 1 procedures. Significant differences with regard to the absolute number of postoperative complications between different groups were not observed; however, their quality varied. Classic methods were used in patients whose general and local condition was more severe.

Conclusions: When AP and its complications are diagnosed, a suitable method of surgical treatment has to be selected extremely precisely and in an individualised way. Minimally invasive methods used in selected patients provide better outcomes and higher safety superseding classic, open techniques of surgical treatment.

Keywords: acute pancreatitis; infected pancreatic necrosis; video-assisted retroperitoneal debridement.

Figures

Photo 1
Photo 1
Flushing drainage after VARD
Photo 2
Photo 2
Sample tomograms of the abdominal cavity of a patient who had percutaneous drainage placed (A) and after VARD (B)

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