Steven Kevin Powell MBCHB, Presenter: Nothing to Disclose

Jonathon Evans MBCHB, Abstract Co-Author: Nothing to Disclose

Aldo Camenzuli MBCHB, Abstract Co-Author: Nothing to Disclose

John Neoptolomos MD, Abstract Co-Author: Nothing to Disclose

Conall John Garvey MBBCH, Abstract Co-Author: Nothing to Disclose

Darshan R. Bakshi MBBS, Abstract Co-Author: Nothing to Disclose

Mark Hughes MBBCH, Abstract Co-Author: Nothing to Disclose

Robert Sutton MBCHB, Abstract Co-Author: Nothing to Disclose

Andrew Edward Healey MBChB, Abstract Co-Author: Nothing to Disclose

Priya Healey MBCHB, Abstract Co-Author: Nothing to Disclose

Peter Rowlands MBCHB, Abstract Co-Author: Nothing to Disclose

Paula Ganeh MBCHB, Abstract Co-Author: Nothing to Disclose

Connor Saxon MBCHB, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To provide a detailed description of the technique of minimally invasive pancreatic necrosectomy employed at the Royal Liverpool Hospital, UK.

Pancreatic necrosis occurs in up to 30% of patients with acute pancreatitis, and can be focal or diffuse. Necrosis is a recognised cause of patient deterioration despite best medical therapy. The degree of necrosis is associated with worsening hyperglycaemia, hypocalcaemia and leucocytosis, and radiologically correlates well with areas of non-enhancement on contrast enhanced computed tomography. The mortality from necrosing pancreatitis is between 30 – 100%. Early surgery is indicated in partial or total necrotising pancreatitis. Open necrosectomy is a considerable undertaking with associated morbidity and mortality. Minimally invasive necrosectomy allows removal of necrotic tissue through a radiologically created tract under direct vision using a necroscope. The indication for minimally invasive pancreatic necrosectomy employed at Royal Liverpool Hospital includes infected pancreatic necrosis or fluid collection, necrosis greater than 50% of the total pancreatic volume, any pancreatic necrosis in a patient not responding to maximum therapy. Our formalised protocol for these patients involves serial CT examinations. Weekly FNA of focal necrosis is performed for culture and sensitivity. Using CT to guide a needle into the necrotic pancreas, the Seldinger technique can be employed to site an 8F pigtail drain in the radiology department. In the operating room the tract is dilated to 20F allowing passage of the necroscope and clearance of necrotic tissue. Following surgery continuous retroperitoneal lavage is applied.

This procedure is a new and exciting therapy in the patient with necrotic pancreatitis. It requires a combined approach from both surgical and radiological teams. We feel that this technique will become the standard for treatment of patients with necrotising pancreatitis.

This discussion of the technique used in minimally invasive pancreatic necrosectomy should be useful for educative and review purposes.

Powell, S, Evans, J, Camenzuli, A, Neoptolomos, J, Garvey, C, Bakshi, D, Hughes, M, Sutton, R, Healey, A, Healey, P, Rowlands, P, Ganeh, P, Saxon, C, et al, , Minimally Invasive Pancreatic Necrosectomy.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4413407.html