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Retroperitoneal endoscopic necrosectomy
1. Retroperitoneal Endoscopic Necrosectomy & “NOTES Pancreatic Necrosectomy” Hakan Yanar MD İstanbul Faculty of Medicine General Surgery Service İstanbul, Turkey 12 th European Congress of Trauma and Emergency Surgery April, 27-30, 2011, Milan
18. Severe Acute Pancreatitis Fine needle aspiration of necrosis (+) (-) Aggresive ICU care Conservative management Necrosis endoscopically accesible Posterior gastric / medical duodenal wall Necrosis in Paracolic gutters Perinephric and Retroduodenal space Endoscopic necrosectomy Laparoscopic necrosectomy or Endoscopic necrosectomy No improvement Surgical drainage
Parenchymal necrosis, as a complication of acute pancreatitis, occurs in 10% to 25% of patients requiring hospital admission, and continues to be associated with mortality rate of approximately 25%.
-Delayed intervention (>2 weeks) is associated with reduced mortality -With later surgical intervention leading to better demarcation of extent of necrosis and maturation of the local inflammatory ressponce
Practically if pt has more than 50 % necrosis it indicates 80 % infection rates.
In our institution, necrosectomy is usually
Endoscopic ultrasound was used to define the optimal puncture position and to exclude vessel interposition. However the use of EUS did not prevent bleeding complications
In pancreatitis thanks got we do not have that kind of tecnique
Castellanos et al concluded that
There are various surgical approaches for removing the necrosum. Minimally invasive retroperitoneal pancreatic necrosectomy (MIRP) is a relatively novel approach with early encouraging results and is safe in the surgical management of well-selected cases of necrotising pancreatitis.
A large fragment of necrosis extruding from the cavity posterior to stomach
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