Retroperitoneal Approach for Surgical Treatment of Infected Pancreatic Necrosis

Authors

  • Sukanya Sriussadaporn Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Abstract

Infected pancreatic necrosis is the most severe form of acute pancreatitis. Without proper management, the mortality rate is very high. Surgical debridement of the infected necrotic tissue and drainage are mainstays of therapy. Several methods of surgical debridement and drainage have been advocated. Various techniques of transperitoneal necrosectomy and drainage are among the recommended surgical treatment. However, reoperation for repeated debridements is usually required and some complications related to the transperitoneal approach may be encountered. The retroperitoneal approach is an alternative which has been previously proposed and reported with satisfactory outcome.

A 42-year old male with infected pancreatic necrosis who underwent repeated surgical removal of the necrotic tissue by retroperitoneal approach via a flank incision is presented. The patient had daily debridement for 14 consecutive days and then changed to once every 2 days with 20 re-operations overall by the retroperitoneal approach during this admission. Massive amounts of necrotic materials were obtained during the early period and decreased to a minimal amount until surgery was discontinued and replaced by daily irrigation of the retroperitoneal area via a tube drain. The patient's clinical condition gradually improved with the flank wound progressively decreasing in size and eventually closing spontaneously. He was discharged on the 80th day after the first operation without evidence of pancreatic exocrine or endocrine insufficiency.

The advantage of this retroperitoneal approach is the avoidance of disturbing the intraperitoneal hollow viscus and subsequent formation of gastrointestinal fistulas. Furthermore, early enteric feeding can be initiated and patient's recovery is enhanced by improved nutritional status.

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Published

2005-03-31

How to Cite

1.
Sriussadaporn S. Retroperitoneal Approach for Surgical Treatment of Infected Pancreatic Necrosis. Thai J Surg [Internet]. 2005 Mar. 31 [cited 2024 Dec. 23];26(1):22-6. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/242250

Issue

Vol. 26 No. 1 (2005): January - March

Section

Original Articles

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Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.