Published online Feb 7, 2022. doi: 10.3748/wjg.v28.i5.588
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
Processing time: 327 Days and 0.1 Hours
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.
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.
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.