Video-assisted retroperitoneal debridement for infected pancreatic necrosis: A single center series

INTRODUCTION AND IMPORTANCE: Open anterior necrosectomy is no longer considered the first approach for the up to 20% of patients with acute pancreatitis who develop infected necrosis. When endoscopic debridement and percutaneous drains fail, video assisted retroperitoneal debridement (VARD) is now the favored surgical approach. CASE PRESENTATION: We report a current patient who underwent the VARD procedure and provide a seven-year follow-up on ten additional patients who underwent the VARD procedure for infected pancreatic necrosis between 2010 and 2015. We analyzed patient demographics, APACHE II scores, length of hospital stay, number of VARD procedures, and surgical complications. CLINICAL DISCUSSION: During this study period, we cared for 320 patients, 59 women, and 261 men, with acute necrotizing pancreatitis. Ten of our patients ultimately underwent the VARD procedure. We report a 50% overall complication rate and a 20% mortality rate. Two of the patients who underwent the VARD procedure had already undergone open necrosectomy; two additional patients in the VARD group required open necrosectomy after the VARD procedure. CONCLUSION: Our current case report demonstrates the effectiveness of the VARD procedure for patients with infected pancreatic necrosis. Our case series provides additional details regarding the significant morbidity and mortality associated with infected pancreatic necrosis. We acknowledge that despite following the step-up protocol, both VARD procedures and open necrosectomy may still be required.