Comparison between video‐assisted retroperitoneal debridement and small incision pancreatic necrosectomy in infected pancreatic necrosis

• Published in: ANZ journal of surgery Vol. 90; no. 10; pp. 2020 - 2025
• Main Authors: Zhang, Jin‐Bao, Sun, Bei
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01.10.2020; Blackwell Publishing Ltd
• Subjects: China; Complications; Debridement; Demography; Drainage; Health services; Humans; infected pancreatic necrosis; minimally invasive surgery; Mortality; Necrosis; Pancreas; pancreatic necrosectomy; Pancreatitis, Acute Necrotizing - surgery; Patients; Resource utilization; Retroperitoneal Space; Retrospective Studies; Statistical analysis; Treatment Outcome; video‐assisted retroperitoneal debridement; China; minimally invasive surgery; video-assisted retroperitoneal debridement; pancreas; infected pancreatic necrosis; pancreatic necrosectomy
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.16181

Background Debridement and drainage have always been mainstream treatment for infected pancreatic necrosis (IPN), and the application of minimally invasive necrosectomy is becoming increasingly widespread. However, few studies have compared video‐assisted retroperitoneal debridement (VARD) and small incision pancreatic necrosectomy (SIPN) individually. Our aim was to compare VARD and SIPN by evaluating outcomes. Methods We retrospectively reviewed patients with IPN who underwent either VARD or SIPN between 2010 and 2019 in China. Data relative to patient demographics, major complications, health care resource utilization and mortality were collected. Statistical analyses used were the two‐tailed Student's t‐test and the chi‐squared test. Results Of 59 patients, 31 patients underwent SIPN and 28 patients were treated with VARD. SIPN and VARD had similar treatment success and mortality rates. The rate of reintervention due to lack of clinical improvement was significantly lower in the SIPN group (32% versus 61%; P = 0.028). In addition, the length of total hospital stay was 60 days in the SIPN group and 72 days in the VARD group (P < 0.0001) and mean total costs was significantly less in the SIPN group than in the VARD group (P = 0.008). Conclusion Given the shorter hospitalization period, lower total cost and lower rate of reinterventions, SIPN may be superior to the step‐up approach for patients with IPN than for those with VARD. Our aim was to evaluate the outcome by comparing video‐assisted retroperitoneal debridement (VARD) and small incision pancreatic necrosectomy (SIPN) for infected pancreatic necrosis. SIPN and VARD are both an effective treatment for infected pancreatic necrosis with acceptable mortality and complication rates. SIPN can reduce the rate of reinterventions due to poor clinical improvement with a shorter hospital stay and a lower total cost compared with VARD.