A technique for laparoscopic-assisted percutaneous drainage of infected pancreatic necrosis and pancreatic abscess

Background: Percutaneous drainage has been shown to be an acceptable method for treating both pancreatic abscesses and infected pancreatic necrosis. H owever, percutaneous techniques have certain shortcomings, including the ti me and labor required and failure of the catheters to adequately drain the particulate debris. Growing experience around the world indicates that ther e is a role for retroperitoneal laparoscopy as a means of facilitating the percutaneous drainage of infected pancreatic fluid collections and avoiding a laparotomy. Our technique is discussed in this paper. Methods: Once infection is documented in a pancreatic fluid collection by f ine-needle aspiration, one or more percutaneous drains are placed into the fluid collection(s). A computed tomography (CT) scan is repeated. If furthe r drainage is indicated, retroperitoneoscopic debridement is performed. Usi ng a combination of the percutaneous drain(s) and the post-drain CT scan, p orts are placed and retroperitoneoscopic debridement of the necrosectum is performed under direct visualization. Prior to completion of the operation, a postoperative lavage system is created. Results: Six patients with infected pancreatic necrosis have been treated w ith this technique. Prior to commencement of our laparoscopic protocol, all six patients would have required open necrosectomy. Four of the six patien ts were managed with retroperitoneoscopic debridement and catheter drainage alone. Complications included a colocutaneous fistula and a small flank he rnia. There were no bleeding complications and no deaths. Conclusion: Although open necrosectomy remains the standard of care for the treatment of infected pancreatic necrosis and pancreatic abscess, there is growing evidence that laparoscopic retroperitoneal debridement is feasible .