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

Objective To describe the development of a minimally invasive technique aimed at surg ical debridement in addition to simple drainage of the abscess cavity. Summary Background Data Surgical intervention for secondary infection of pancreatic necrosis is ass ociated with a death rate of 25% to 40%. Although percutaneous approaches m ay drain the abscess, they have often failed in the long term as a result o f inability to remove the necrotic material adequately. Methods Fourteen consecutive patients with infected necrosis secondary to acute pan creatitis were studied. The initial four patients underwent sinus tract end oscopy along a drainage tract for secondary sepsis after prior open necrose ctomy. This technique was then modified to allow primary debridement for pr oven sepsis to be carried out percutaneously in a further 10 patients. The techniques and initial results are described. Results 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 inpati ent stay was 42 days. There was one conversion for intraoperative bleeding. Eight patients recovered and were discharged from the hospital after a med ian of three percutaneous explorations. Only 40% of patients required inten sive care management after surgery. Conclusions These initial results in an unselected group of patients are encouraging an d show that unlike with percutaneous or endoscopic techniques, both resolut ion of sepsis and adequate necrosectomy can be achieved. The authors' initi al impression of a reduction in postoperative organ dysfunction is particul arly interesting; however, the technique requires further evaluation in a l arger prospective series.