Portal de Periódicos da CAPES

Surgery in the Treatment of Acute Pancreatitis Minimal Access Pancreatic Necrosectomy

2005; SAGE Publishing; Volume: 94; Issue: 2 Linguagem: Inglês

10.1177/145749690509400210

1799-7267

Saxon Connor, Michael Raraty, Nathan Howes, Jonathan Evans, Paula Ghaneh, Robert Sutton, John P. Neoptolemos,

Gastrointestinal disorders and treatments

Between 5% and 10% of patients with acute pancreatitis will develop infected pancreatic necrosis. Traditional open surgery for this condition carries a mortality rate of up to 50%, and therefore a number of less invasive techniques have been developed, including radiological drainage and a minimal access retroperitoneal approach. No randomised controlled trials have been published which compare these techniques. Indications for minimal access surgery are the same as for open surgery, i.e. infected pancreatic necrosis or failure to improve with extensive sterile necrosis. Access is obtained to the pancreatic necrosis via the left loin and necrosectomy performed using an operating nephroscope, and this often requires several procedures to remove all necrotic tissue. The cavity is continuously irrigated on the ward in between procedures. The results of this approach are encouraging, with less systemic upset to the patient, a lower incidence of post-operative organ failure when compared with open surgery, and a reduced requirement for ITU support. There is also a trend towards a lower mortality rate, although this does not reach statistical significance on the data published so far. Current evidence suggests that a minimal access approach to pancreatic necrosis is feasible, well tolerated and beneficial for the patient when compared with open surgery.