Comparison Study of Necrosectomy by Retroperitoneal Approach with Transperitoneal Approach - For Infected Pancreatic Necrosis

Arun K .

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.

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