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  • Title: Debridement and drainage of walled-off pancreatic necrosis by a novel laparoendoscopic rendezvous maneuver: experience with 6 cases.
    Author: Fischer A, Schrag HJ, Keck T, Hopt UT, Utzolino S.
    Journal: Gastrointest Endosc; 2008 May; 67(6):871-8. PubMed ID: 18367186.
    Abstract:
    BACKGROUND: Walled-off pancreatic necrosis (WOPN) is a known complication of acute and chronic pancreatitis. Indications for treatment of WOPN are infection, a rapid increase in size, pain, or biliary or duodenal obstruction. Endoscopic transgastric treatment of pseudocysts with liquid content is successful in approximately 90% of patients; however, the treatment of WOPN is less satisfactory. OBJECTIVE: A demonstration of a novel minimally invasive approach to adequately remove and drain pancreatic necrosis. DESIGN: Between June 2004 and June 2006, a nonrandomized observational study was conducted with 6 consecutive patients. WOPN was treated by a minimally invasive laparoendoscopic rendezvous technique. SETTING: All patients were examined at the university hospital in Freiburg, Germany. PATIENTS: Six patients were treated for WOPN of an average diameter of 13 cm (range 9-20 cm). In 5 cases, the WOPN was a consequence of acute pancreatitis; there was 1 case of chronic pancreatitis. The average interval between diagnosis and initial treatment was 14 weeks (range 6-20 weeks). RESULTS: Conventional surgery was avoided in 5 patients (83%) over a median follow-up of 14 months (range 1.5-27 months). Six endoscopic sessions (range 4-11) were performed during the entire treatment period. One patient needed emergency surgery on day 4 after the intervention for a perforation because of gastric-wall separation from the necrotic cavity. There was 1 lethal gastric variceal bleeding, which occurred when a gastrostomy tube was removed 46 days after the initial treatment. LIMITATION: The small number of patients. CONCLUSIONS: In selected cases, minimally invasive laparoendoscopic treatment of WOPN is possible without the need of laparotomy or laparoscopy.
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