Laparoscopic assisted percutaneous drainage of infected pancreatic necrosis

Background: Percutaneous drainage of infected pancreatic fluid collections is often unsuccessful. Alternatively, open necrosectomy techniques are very morbid. We hypothesized that in selected cases, laparoscopic techniques co uld be used to facilitate percutaneous drainage of the residual particulate necrosectum and avoid a laparotomy. We report our experience with laparosc opic assisted retroperitoneal debridement as an adjunct to percutaneous dra inage for patients with infected pancreatic necrosis. Methods: Case studies were reviewed retrospectively. We analyzed the course of six patients undergoing laparoscopic assisted debridement of infected p ancreatic necrosis after failure of percutaneous drainage. With the drains and computed tomography (CT) scan used as a guide, laparoscopic debridement of the necrosectum was performed. Results: Between November 1995 and December 1999, six patients were treated with this method. In four patients, laparoscopic assisted percutaneous dra inage was successful. Two patients required open laparotomy. Complications included a self-limited enterocutaneous fistula and a small flank hernia. N o deaths occurred. Conclusions: This early, limited experience has demonstrated the feasibilit y of laparoscopic assisted percutaneous drainage for infected pancreatic ne crosis. With this technique, two-thirds of our patients avoided the morbidi ty of a laparotomy.