Retroperitoneal endoscopic necrosectomy
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1) Retroperitoneal endoscopic necrosectomy and NOTES pancreatic necrosectomy are minimally invasive techniques for treating infected pancreatic necrosis as an alternative to open necrosectomy. 2) The document describes various management techniques for infected pancreatic necrosis including percutaneous drainage, endoscopic approaches, laparoscopic debridement, and retroperitoneal approaches. 3) Case studies demonstrate the use of techniques like transgastric endoscopic necrosectomy, retroperitoneal necrosectomy, and endoscopic cystogastrostomy to treat infected pancreatic necrosis.
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Retroperitoneal endoscopic necrosectomy
- 1. Retroperitoneal Endoscopic Necrosectomy & “NOTES Pancreatic Necrosectomy” Hakan Yanar MD İstanbul Faculty of Medicine General Surgery Service İstanbul, Turkey 12 th European Congress of Trauma and Emergency Surgery April, 27-30, 2011, Milan
- 7. Hughes SJ, et al. Gastroenterol Clin N Am, 2007
- 11. Endo US Endoscopic ultrasound: - to define the optimal puncture position - to exclude vessel interposition.
- 14. OPEN SURGERY IS
- 16. Which management technique of infected necroses
- 18. Severe Acute Pancreatitis Fine needle aspiration of necrosis (+) (-) Aggresive ICU care Conservative management Necrosis endoscopically accesible Posterior gastric / medical duodenal wall Necrosis in Paracolic gutters Perinephric and Retroduodenal space Endoscopic necrosectomy Laparoscopic necrosectomy or Endoscopic necrosectomy No improvement Surgical drainage
- 26. Gas inclusion in pancreatic necrosis
- 30. Vaka 4
- 33. Minimally Invasive Technique Retroperitoneal Necrosectomy
- 37. Before After
- 39. August 18
- 40. September 15 Before endoscopic cystogastrostomy
- 42. October 3 After endoscopic cystogastrostomy
- 43. October 18, re-cyctogastrostomy /2nd seance
- 44. December, 13
Editor's Notes
- Parenchymal necrosis, as a complication of acute pancreatitis, occurs in 10% to 25% of patients requiring hospital admission, and continues to be associated with mortality rate of approximately 25%.
- -Delayed intervention (>2 weeks) is associated with reduced mortality -With later surgical intervention leading to better demarcation of extent of necrosis and maturation of the local inflammatory ressponce
- Practically if pt has more than 50 % necrosis it indicates 80 % infection rates.
- In our institution, necrosectomy is usually
- Endoscopic ultrasound was used to define the optimal puncture position and to exclude vessel interposition. However the use of EUS did not prevent bleeding complications
- In pancreatitis thanks got we do not have that kind of tecnique
- Castellanos et al concluded that
- There are various surgical approaches for removing the necrosum. Minimally invasive retroperitoneal pancreatic necrosectomy (MIRP) is a relatively novel approach with early encouraging results and is safe in the surgical management of well-selected cases of necrotising pancreatitis.
- A large fragment of necrosis extruding from the cavity posterior to stomach