Post-Discharge Outcomes After Pancreatic Necrosectomy: A Single Institution Experience Following Endoscopic vs Open Debridement

Background Pancreatic necrosectomy outcomes have been studied extensively; however, long-term results of these procedures have not been well characterized. Our study aimed to assess the outcomes at and after discharge for patients following necrosectomy. Methods Data from patients undergoing pancreatic necrosectomy at a single tertiary referral hospital from January 1, 2007, to June 1, 2019 were retrospectively analyzed. Patients were stratified into an open pancreatic necrosectomy (OPN) and an endoscopic pancreatic necrosectomy (EPN) group. Results Cohorts were composed of an OPN (n = 30) and EPN (n = 31) groups with a mean follow-up of 22 and 13.5 months, respectively. There was no statistically significant difference in the demographics or etiology of disease; however, the presence of severe sepsis and elevated BISAP scores was significantly higher in the OPN group (40% vs 13% p = .016, 37% vs 10% p = .012, respectively). There was no significant difference in discharge parameters or disposition other than a higher need for wound care in the OPN group (14% vs 0% p =< .0001). No significant difference in the number of patients who returned to baseline, 12-month ED visits, 12-month readmissions, medical comorbidities, or long-term survival was noted. Conclusions Previous studies have demonstrated that OPN patients have a higher severity of disease and higher inpatient mortality; however, this does not hold true once the acute phase of the illness has passed. Long-term medical comorbidities and survival of patients with necrotizing pancreatitis who endure the primary insult do not differ in long term, regardless of the debridement modality performed for source control.

Two port laparoscopic retroperitoneal pancreatic necrosectomy: improvement in morbidity and mortality with a less invasive approach

Background: Severe pancreatitis is associated with a high rate of mortality even with advanced surgical care and practices worldwide. Morbidity and mortality rates are much higher in the presence of infected pancreatic necrosis. From open necrosectomy, simple percutaneous drainage or one of several minimal access approaches, the question of optimal or best treatment is yet debatable. Step-up approach is currently practised by many physicians. We describe our technique of early drainage by minimal invasive two-port laparoscopic retroperitoneal pancreatic necrosectomy in our centre.Methods: Thirteen consecutive patients with proven infected pancreatic necrosis were treated by 2P-LRPN over a two-year period in the setting of a teaching hospital. The median patient age was 44 years (range: 28-66 years) and 10 of the patients were male.Results: The median time to discharge following the procedure of 14 days (range: 08-21 days). There was no mortality and the morbidity rate was 37%, consisting mainly of pancreatic fistula (37%).Conclusions: Two-port laparoscopic retroperitoneal pancreatic necrosectomy is an effective and minimally invasive procedure which had better outcomes with improved patient morbidity, shorter hospital stay and lesser complication rate. Early intervention with necrosectomy has better patient compliance.

Retroperitoneoscopic Pancreatic Necrosectomy: Taming the Relentless March of the Great Marauder

We hereby report a case of a 35-year-old male who presented to us with infected pancreatic necrosis, 4 weeks after an episode of acute alcoholic pancreatitis. Imaging investigations showed a predominantly left-sided pancreatic and peripancreatic infected collection. This case was managed successfully in a single sitting by retroperitoneoscopic intervention.