Pancreatitis surgery (necrosectomy) - approaches, tips and tricks
Surgical treatment for infected necrotizing pancreatitis has multiple options such as internal drainage by endoscopic transgastric necrosectomy, laparoscopic pancreatic necrosectomy, percutaneous external drainage, as well as Video-assisted retroperitoneal debridement or VARD. Also, the resulting postoperative external pancreatic fistula can become persistent external pancreatic fistula due to disconnected duct syndrome which may entail a distal pancreatectomy or fistulojejunostomy or lateral pancreaticojejunostomy.
All these options are discussed in this video along with their pros and cons, the decision making as per the case discussed, and the actual tips and tricks for performing each of them from our experts such as Dr. Paresh Varty, Dr. Prasad Wagle, Dr. Rahul Sheth, Dr. Mehul Choksi, Dr. Rajvilas Narkhede, and Dr. Prasad Pande.
Pancreatic debridement techniques are used to manage infected or symptomatic walled-off pancreatic/ peripancreatic necrosis as per the revised Atlanta Classification of acute pancreatitis. These are discussed in this panel discussion. The Step-up approach described in the Panter trial has been the gold standard for treating these patients and this approach has also been discussed in detail.
For FURTHER READING:
The Panter trial, Penguin trial, and Tension trial are the key trials that should be read by interested colleagues who manage these cases routinely. These have been the go-to trial designs to manage these cases. The new kid on the block is the endoscopic treatment of necrotizing pancreatitis and Dr. Mehul Choksi has described this technique in detail in this video. Dr. Paresh Varty has published data on video-assisted retroperitoneal debridement and he shares his experiences on the same in this discussion as well.
Severe acute and necrotizing pancreatitis management have undergone a paradigm shift with the minimally invasive approaches coming up and these are discussed by our experts here. Step-up to VARD vs laparoscopic transgastric necrosectomy vs endoscopic necrosectomy are all discussed in this video so, do have a look and share your experiences in the comments.