Lindgaard L, Lauritsen ML, Novovic S, Hansen EF, Karstensen JG, Schmidt PN. Simultaneous endoscopic and video-assisted retroperitoneal debridement in walled-off pancreatic necrosis using a laparoscopic access platform: Two case reports. World J Gastroenterol 2022; 28(5): 588-593 [PMID: 35316956 DOI: 10.3748/wjg.v28.i5.588]
Corresponding Author of This Article
John Gásdal Karstensen, MD, PhD, Associate Professor, Chief Physician, Surgeon, Pancreatitis Centre East (PACE), Gastro Unit, Copenhagen University Hospital–Amager and Hvidovre, Kettegård Alle 30, Hvidovre 2650, Capital Region, Denmark. john.gasdal.karstensen@regionh.dk
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Feb 7, 2022; 28(5): 588-593 Published online Feb 7, 2022. doi: 10.3748/wjg.v28.i5.588
Simultaneous endoscopic and video-assisted retroperitoneal debridement in walled-off pancreatic necrosis using a laparoscopic access platform: Two case reports
Lars Lindgaard, Morten Laksáfoss Lauritsen, Srdan Novovic, Erik Feldager Hansen, John Gásdal Karstensen, Palle Nordblad Schmidt
Lars Lindgaard, Morten Laksáfoss Lauritsen, Srdan Novovic, Erik Feldager Hansen, John Gásdal Karstensen, Palle Nordblad Schmidt, Pancreatitis Centre East (PACE), Gastro Unit,Copenhagen University Hospital–Amager and Hvidovre, Hvidovre 2650, Capital Region, Denmark
Morten Laksáfoss Lauritsen, Srdan Novovic, John Gásdal Karstensen, Department of Clinical Medicine, University of Copenhagen, Copenhagen 2100, Capital Region, Denmark
Author contributions: Lindgaard L, Novovic S, Hansen EF, and Schmidt PN designed the study; Lindgaard L and Schmidt PN drafted the manuscript; Karstensen JG edited the manuscript; all authors critically revised the manuscript and approved the final content.
Informed consent statement: Written informed consent was obtained from the patients for publication of their case details and accompanying images.
Conflict-of-interest statement: We declare no conflict of interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: John Gásdal Karstensen, MD, PhD, Associate Professor, Chief Physician, Surgeon, Pancreatitis Centre East (PACE), Gastro Unit, Copenhagen University Hospital–Amager and Hvidovre, Kettegård Alle 30, Hvidovre 2650, Capital Region, Denmark. john.gasdal.karstensen@regionh.dk
Received: March 4, 2021 Peer-review started: March 4, 2021 First decision: May 1, 2021 Revised: May 3, 2021 Accepted: December 28, 2021 Article in press: December 28, 2021 Published online: February 7, 2022
Abstract
BACKGROUND
Infected walled-off necrosis is a potentially life-threatening complication of necrotizing pancreatitis. While some patients can be treated by drainage alone, many patients also need evacuation of the infected debris. Central necroses in relation to the pancreatic bed are easily reached via an endoscopic transluminal approach, whereas necroses that involve the paracolic gutters and the pelvis are most efficiently treated via a percutaneous approach. Large and complex necroses may need a combination of the two methods.
CASE SUMMARY
Transluminal and percutaneous drainage followed by simultaneous endoscopic and modified video-assisted retroperitoneal debridement was carried out in two patients with very large (32-38 cm), infected walled-off necroses using a laparoscopic access platform. After 34 d and 86 d and a total of 9 and 14 procedures, respectively, complete regression of the walled-off necroses was achieved. The laparoscopic access platform improved both access to the cavities as well as the overview. Simultaneous transluminal and percutaneous necrosectomy are feasible with the laparoscopic access platform serving as a useful adjunctive.
CONCLUSION
This approach may be necessary to control infection and achieve regression in some patients with complex collections.
Core Tip: Infected walled-off necrosis is a potentially life-threatening complication of necrotizing pancreatitis. In cases with large or complex walled-off necrosis, treatment combining endoscopic, transluminal and percutaneous video-assisted retroperitoneal debridement may be needed. We report on two patients who underwent a combination of endoscopic and percutaneous drainage and necrosectomy for their large, infected walled-off necroses. Furthermore, we introduce a laparoscopic access platform as a useful adjunctive to endoscopic necrosectomy and video-assisted retroperitoneal debridement.
