Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pancreatic necrosis : An initial experience

• Published in: Annals of surgery 2000-08, Vol.232 (2), p.175-180
• Main Authors: CARTER, C. R, MCKAY, C. J, IMRIE, C. W
• Format: Article
• Language: English
• Subjects: Adult; Advances in Surgical Technique; Aged; Biological and medical sciences; Endoscopy; Female; Humans; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; Minimally Invasive Surgical Procedures; Pancreatitis, Acute Necrotizing - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/00000658-200008000-00004

To describe the development of a minimally invasive technique aimed at surgical debridement in addition to simple drainage of the abscess cavity. Surgical intervention for secondary infection of pancreatic necrosis is associated with a death rate of 25% to 40%. Although percutaneous approaches may drain the abscess, they have often failed in the long term as a result of inability to remove the necrotic material adequately. Fourteen consecutive patients with infected necrosis secondary to acute pancreatitis were studied. The initial four patients underwent sinus tract endoscopy along a drainage tract for secondary sepsis after prior open necrosectomy. This technique was then modified to allow primary debridement for proven sepsis to be carried out percutaneously in a further 10 patients. The techniques and initial results are described. Additional surgery for sepsis was successfully avoided in the initial four patients managed by sinus tract endoscopy, and none died. Of the following 10 patients managed by percutaneous necrosectomy, 2 died. The median inpatient stay was 42 days. There was one conversion for intraoperative bleeding. Eight patients recovered and were discharged from the hospital after a median of three percutaneous explorations. Only 40% of patients required intensive care management after surgery. These initial results in an unselected group of patients are encouraging and show that unlike with percutaneous or endoscopic techniques, both resolution of sepsis and adequate necrosectomy can be achieved. The authors' initial impression of a reduction in postoperative organ dysfunction is particularly interesting; however, the technique requires further evaluation in a larger prospective series.