Comparison Study of Necrosectomy by Retroperitoneal Approach with Transperitoneal Approach - For Infected Pancreatic Necrosis
Abstract
Background: Minimally invasive necrosectomy through a retroperitoneal approach has shown promising results for the treatment of infected pancreatic necrosis.
Aim: To perform comparison of patients with infected pancreatic necrosis who underwent necrosectomy by retroperitoneal approach with transperitoneal approach.
Methods: Retrospective analysis of prospectively maintained database of infected pancreatic necrosis patients treated between August 2013 and July 2016. Totally 77 patients were admitted with infected pancreatic necrosis. Conservatively managed -9 ; PCD alone- 22; PCD followed by TPN/RPN -11 ; Transperitoneal necrosectomy-26(TPN alone -23; PCD followed by TPN -3) Retroperitoneal necrosectomy-20(left flank -18; right flank -01;Bilateral- 1)( RPN alone-11; PCD followed by RPN -9); Prophylactic ileostomy done in 2 cases in RPN & 2 cases in TPN (suspicion of bowel communication). 16 Patients from each group were matched for the age (10 years), status of infection, CT severity score (2 points), preoperative organ failure and timing for surgery ( for 7 days).
Results: Reintervention was required in 4 patients (ileostomy -3 & redo necrosectomy -1 ) in the RP group ; 2 patients in the TP group (ileostomy -2); Ileostomy done for postoperative fecal fistula. Median post operative hospital stay was 22 days in the RP group and 25days in the TP group . Mortality was observed in 5 cases in TP group (4 due to MODS; 1due to fecal fistula); 2 cases in RPN (1 due to MODS & 1 due to fecal fistula)
Conclusions: Comparing to TP approach , RP approach for pancreatic necrosectomy through a small flank incision was associated with more morbidity though insignificant P value( mainly because of bowel injury in RP group )comparable postop hospital stay but less mortality though insignificant P value.Full Text:
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