Brief Article
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Dec 14, 2012; 18(46): 6829-6835
Published online Dec 14, 2012. doi: 10.3748/wjg.v18.i46.6829
Minimally invasive treatment of pancreatic necrosis
Brian Bello, Jeffrey B Matthews
Brian Bello, Jeffrey B Matthews, Department of Surgery, School of Medicine, University of Chicago, Chicago, IL 60637, United States
Author contributions: Bello B and Matthews JB wrote the paper.
Correspondence to: Jeffrey B Matthews, MD, FACS, Professor, Chairman, Department of Surgery, University of Chicago, 5841 S Maryland Ave, MC5029, Chicago, IL 60637, United States. jmatthews@uchicago.edu
Telephone: +1-773-7020881 Fax: +1-773-7022140
Received: April 18, 2012
Revised: September 3, 2012
Accepted: September 6, 2012
Published online: December 14, 2012
Abstract

AIM: To systematically review these minimally invasive approaches to infected pancreatic necrosis.

METHODS: We used the MEDLINE database to investigate studies between 1996 and 2010 with greater than 10 patients that examined these techniques. Using a combination of Boolean operators, reports were retrieved addressing percutaneous therapy (341 studies), endoscopic necrosectomy (574 studies), laparoscopic necrosectomy via a transperitoneal approach (148 studies), and retroperitoneal necrosectomy (194 studies). Only cohorts with at least 10 or more patients were included. Non-English papers, letters, animal studies, duplicate series and reviews without original data were excluded, leaving a total of 27 studies for analysis.

RESULTS: Twenty-seven studies with 947 patients total were examined (eight studies on percutaneous approach; ten studies on endoscopic necrosectomy; two studies on laparoscopic necrosectomy via a transperitoneal approach; five studies on retroperitoneal necrosectomy; and two studies on a combined percutaneous-retroperitoneal approach). Success rate, complications, mortality, and number of procedures were outcomes that were included in the review. We found that most published reports were retrospective in nature, and thus, susceptible to selection and publication bias. Few reports examined these techniques in a comparative, prospective manner.

CONCLUSION: Each minimally invasive approach though was found to be safe and feasible in multiple reports. With these new techniques, treatment of infected pancreatic necrosis remains a challenge. We advocate a multidisciplinary approach to this complex problem with treatment individualized to each patient.

Keywords: Acute pancreatitis; Pancreatic abscess; Pancreatic necrosis; Necrosectomy; Laparoscopic necrosectomy