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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
Notas del editor
- 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