Figure 4 - uploaded by Antonio Marmolejo
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Retroperitoneal access to the lesser sac. Black arrows: direction of the dissection between the K and the C. K, left kidney; C, transverse colon; St, stomach; TP, tail of pancreas; S, spleen.
Source publication
Abstract: Acute pancreatitis (AP) is an inflammatory condition that includes local and systemic
manifestations, showing a mild behavior in most patients. Infected pancreatic necrosis is the most
aggressive scenario with a high mortality rate. According to the PANTER trial, the “step-up approach”
has shown a lower rate of new-onset organ failure com...
Context in source publication
Context 1
... must be focused on loose necrotic tissue, preserving the vitalized and vascularized pancreatic tissue. Body and tail pancreas necrosis: the left-side dissection is limited by the posterior gastric wall anteriorly, the inferior pole of the spleen, and the anterior renal fascia posteriorly, having the transverse colon with its mesocolon as the inferior limit (Figure 4). Take care of the splenic artery and its branches crossing this plane to the splenic hilum. ...
Citations
Introduction and importance
The incidence of acute pancreatitis varies globally, and its rates are increasing. Timely intervention in cases of infected necrosis is crucial to effective management. The landscape of acute pancreatitis management has undergone transformation through adopting a “step-up” strategy, accentuating the shift towards minimally invasive techniques.
Case presentation
A 63-year-old patient with acute pancreatitis and infected pancreatic necrosis underwent a challenging yet successful treatment using video-assisted retroperitoneal debridement employing a two-port approach facilitated access for an intricate area. The procedure, performed 45 days after admission, effectively reduced peripancreatic collections, demonstrating the efficacy of this approach in managing complex cases of infected pancreatic necrosis.
Clinical discussion
The management of acute pancreatitis has evolved towards a comprehensive strategy involving early hydration, nutritional support, effective pain management, and interventions. Infected pancreatic necrosis poses a serious complication, with minimally invasive techniques such as video-assisted retroperitoneal debridement (VARD) emerging as preferred options. The efficacy and safety of VARD in complex cases are highlighted, although challenges persist, especially in extensive necrosis.
Conclusion
The VARD procedure, a key component of the step-up approach, exhibits a remarkable safety profile, substantially reducing postoperative complications and mortality compared to open surgical counterparts. However, challenges persist in managing cases of infected Walled-Off Necrosis with deep extension, necessitating carefully considering a minimal-access approach. We report our experience using the VARD in a two-port approach.
