Retrolaparoscopy in treatment of severe acute pancreatitis complicated with infected pancreatic necrosis: report of 20 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIU Jianming , XIONG Yu , SU Yongjie , LIU Pingguo ,  WU Shaofeng

1. Department of Hepatobiliary Surgery, Zhongshan Hospital Affiliated to Xiamen University, Fujian Provincial Key Laboratory of Chronic Liver Disease and Hepatocellular Carcinoma, Xiamen, Fujian 361004, P. R. China;

Corresponding author：

WU Shaofeng, Email: wushaofengxm@163.com

Keywords：

severe acute pancreatitis; infectious pancreatic necrosis; retrolaparoscopy

DOI：

10.7507/1007-9424.202401052

Video：

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Objective To explore the safety and feasibility of retrolaparoscopy in treatment of severe acute pancreatitis complicated with infected pancreatic necrosis. Methods Clinical data of 20 patients with severe acute pancreatitis complicated with infectious pancreatic necrosis who received retrolaparoscopy treatment in our hospital from May 2017 to May 2022 were retrospectively collected. Results Among the 20 patients, 18 patients underwent percutaneous catheter drainage, 1 pregnant patient with severe acute pancreatitis underwent laparotomy drainage in the first phase, and 1 patient underwent laparotomy drainage in the first phase from another hospital. All patients underwent successful retroperitoneal drainage, microscopic debridement and drainage were performed. The operation time was 68–106 minutes, (89.8±11.7) minutes; intraoperative bleeding was 100–300 mL, (171.3±61.0) mL; hospitalization was 28–62 d, with median time of 48 d. After the operation, the systemic poisoning symptoms of the patients were quickly relieved. One patient underwent twice retroperitoneoscopic debridement surgeries, and the remaining patients underwent only once retroperitoneoscopic debridement drainage surgery. There were no complications in 17 patients, but 1 patient was complicated by colonic fistula after surgery, 2 patients suffered from abdominal bleeding. After the operation, 20 patients were interviewed, and the follow-up time was 6–62 months, with the median of 31 months. During postoperative follow-up period, the patients’ symptoms completely disappeared and there was no recurrence. Conclusion The retrolaparoscopic approach in treatment of severe acute pancreatitis complicated with infected pancreatic necrosis is safe and effective, and has few complications.

Citation： LIU Jianming, XIONG Yu, SU Yongjie, LIU Pingguo, WU Shaofeng. Retrolaparoscopy in treatment of severe acute pancreatitis complicated with infected pancreatic necrosis: report of 20 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(2): 189-192. doi: 10.7507/1007-9424.202401052 Copy

1.	Hartwig W, Werner J, Uhl W, et al. Management of infection in acute pancreatitis. J Hepatobiliary Pancreat Surg, 2002, 9(4): 423-428.
2.	Leppäniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg, 2019, 14: 27. doi: 10.1186/s13017-019-0247-0.
3.	Mowery NT, Bruns BR, MacNew HG, et al. Surgical management of pancreatic necrosis: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg, 2017, 83(2): 316-327.
4.	中华医学会外科学分会胰腺外科学组. 中国急性胰腺炎诊治指南(2021). 中华外科杂志, 2021, 59(7): 578-587.
5.	Zhang X, Fu B, Lang B, et al. Technique of anatomical retroperitoneoscopic adrenalectomy with report of 800 cases. J Urol, 2007, 177(4): 1254-1257.
6.	刘荣, 张煊. 腹腔镜手术治疗重症急性胰腺炎策略及要点. 中国实用外科杂志, 2015, 35(5): 493-495.
7.	van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology, 2011, 141(4): 1254-1263.
8.	Rodriguez JR, Razo AO, Targarona J, et al. Debridement and closed packing for sterile or infected necrotizing pancreatitis: insights into indications and outcomes in 167 patients. Ann Surg, 2008, 247(2): 294-299.
9.	Trikudanathan G, Wolbrink DRJ, van Santvoort HC, et al. Current concepts in severe acute and necrotizing pancreatitis: an evidence-based approach. Gastroenterology, 2019, 156(7): 1994-2007.e3.
10.	Uhl W, Warshaw A, Imrie C, et al. IAP Guidelines for the Surgical Management of Acute Pancreatitis. Pancreatology, 2002, 2(6): 565-573.
11.	Besselink MG, van Santvoort HC, Nieuwenhuijs VB, et al. Minimally invasive ‘step-up approach’ versus maximal necrosectomy in patients with acute necrotising pancreatitis (PANTER trial): design and rationale of a randomised controlled multicenter trial [ISRCTN13975868]. BMC Surg, 2006, 6: 6. doi: 10.1186/1471-2482-6-6.
12.	Sleeman D, Levi DM, Cheung MC, et al. Percutaneous lavage as primary treatment for infected pancreatic necrosis. J Am Coll Surg, 2011, 212(4): 748-752, 752-754.
13.	van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med, 2010, 362(16): 1491-1502.
14.	Hollemans RA, Bakker OJ, Boermeester MA, et al. Superiority of step-up approach vs open necrosectomy in long-term follow-up of patients with necrotizing pancreatitis. Gastroenterology, 2019, 156(4): 1016-1026.
15.	苗毅, 黄东亚, 李强, 等. 从“step-up”到“step-jump”—感染坏死性胰腺炎“跨阶梯”治疗. 中国实用外科杂志, 2020, 40(11): 1251-1254.

1. Hartwig W, Werner J, Uhl W, et al. Management of infection in acute pancreatitis. J Hepatobiliary Pancreat Surg, 2002, 9(4): 423-428.
2. Leppäniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg, 2019, 14: 27. doi: 10.1186/s13017-019-0247-0.
3. Mowery NT, Bruns BR, MacNew HG, et al. Surgical management of pancreatic necrosis: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg, 2017, 83(2): 316-327.
4. 中华医学会外科学分会胰腺外科学组. 中国急性胰腺炎诊治指南(2021). 中华外科杂志, 2021, 59(7): 578-587.
5. Zhang X, Fu B, Lang B, et al. Technique of anatomical retroperitoneoscopic adrenalectomy with report of 800 cases. J Urol, 2007, 177(4): 1254-1257.
6. 刘荣, 张煊. 腹腔镜手术治疗重症急性胰腺炎策略及要点. 中国实用外科杂志, 2015, 35(5): 493-495.
7. van Santvoort HC, Bakker OJ, Bollen TL, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology, 2011, 141(4): 1254-1263.
8. Rodriguez JR, Razo AO, Targarona J, et al. Debridement and closed packing for sterile or infected necrotizing pancreatitis: insights into indications and outcomes in 167 patients. Ann Surg, 2008, 247(2): 294-299.
9. Trikudanathan G, Wolbrink DRJ, van Santvoort HC, et al. Current concepts in severe acute and necrotizing pancreatitis: an evidence-based approach. Gastroenterology, 2019, 156(7): 1994-2007.e3.
10. Uhl W, Warshaw A, Imrie C, et al. IAP Guidelines for the Surgical Management of Acute Pancreatitis. Pancreatology, 2002, 2(6): 565-573.
11. Besselink MG, van Santvoort HC, Nieuwenhuijs VB, et al. Minimally invasive ‘step-up approach’ versus maximal necrosectomy in patients with acute necrotising pancreatitis (PANTER trial): design and rationale of a randomised controlled multicenter trial [ISRCTN13975868]. BMC Surg, 2006, 6: 6. doi: 10.1186/1471-2482-6-6.
12. Sleeman D, Levi DM, Cheung MC, et al. Percutaneous lavage as primary treatment for infected pancreatic necrosis. J Am Coll Surg, 2011, 212(4): 748-752, 752-754.
13. van Santvoort HC, Besselink MG, Bakker OJ, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med, 2010, 362(16): 1491-1502.
14. Hollemans RA, Bakker OJ, Boermeester MA, et al. Superiority of step-up approach vs open necrosectomy in long-term follow-up of patients with necrotizing pancreatitis. Gastroenterology, 2019, 156(4): 1016-1026.
15. 苗毅, 黄东亚, 李强, 等. 从“step-up”到“step-jump”—感染坏死性胰腺炎“跨阶梯”治疗. 中国实用外科杂志, 2020, 40(11): 1251-1254.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Retrolaparoscopy in treatment of severe acute pancreatitis complicated with infected pancreatic necrosis: report of 20 cases

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