Department of Hepatobiliary Surgery, the First People's Hospital of Changde City, Changde, Hunan 415003, China
Background and Aims In recent years, comprehensive treatment through multidisciplinary collaboration has made some progress in the management of severe acute pancreatitis (SAP). However, infected pancreatic necrosis (IPN) is still a recognized challenge in the treatment of SAP and is also critical to the treatment efficacy of SAP. This study was to analyze and summarize the clinical efficacy of small incision combined with endoscopic minimally invasive surgery in the treatment of IPN.Methods The clinical data of 9 patients with IPN receiving the treatment of small incision combined with endoscopic minimally invasive surgery in the Department of Hepatobiliary Surgery of Changde First People's Hospital from June 2019 to June 2021 were retrospectively analyzed.Results Of the 9 patients, 7 were males and 2 were females, with an average age of (46.7±11.6) years; 5 cases were hyperlipidemic pancreatitis, 2 cases were biliary pancreatitis and 2 cases were alcoholic pancreatitis; the positive rate of the bacterial and fungal culture of pus was 77.8% (7/9). Small incision combined with endoscopic minimally invasive surgery was completed in all patients, which was performed via the left retroperitoneal approach in 4 cases, via the small omental sac approach in 3 cases, and the combined approach in 2 cases. The time from the onset of pancreatitis to the first operation was (47.2±10.1) d, the length of postoperative hospital stay was (20.4±9.6) d, the total length of hospital stay was (36.1±18.1) d, the operative time was (151.7±55.2) min, the weight of necrotic tissue removed was (240.0±119.6) g, the volume of intraoperative blood loss was (55.4±44.2) mL, and the median number of drainage tubes placed was 4 (3-6). Eight patients were cured by one session of surgery, and one patient underwent percutaneous drainage of peripancreatic abscess and choledochoscopic operation again after the first operation. Postoperative complications occurred in 2 patients, including one case of abdominal hemorrhage and one case of colonic fistula. All 9 patients were uneventfully discharged smoothly, and no death occurred.Conclusion Small incision combined with minimally invasive endoscopic surgery integrates the advantages of multiple minimally invasive techniques, which balances the contradiction between debridement efficiency and surgical trauma. It can efficiently and thoroughly remove the necrotic tissues while ensuring the safety of patients at the same time. So, it is recommended to be promoted.
BU Hao, WU Haoran, YE Jinsong, LIU Youyuan, LI Hui, ZHAO Kai, LIU Shengjun. Efficacy analysis of mini-incision access combined with endoscopic pancreatic necrosectomy for infected pancreatic necrosis: a report of 9 cases[J]. Chin J Gen Surg,2022,31(9):1173-1181.