Analysis of Residual Pancreatic Bed Necrosis Using Computed Tomography Following Minimally Invasive Necrosectomy

Abstract

In a unit practicing minimally invasive pancreatic necrosectomy (MIPN), our aim was to assess whether tomographic residual necrotic volume was an objective indicator for repeat necrosectomy. Prospective study of acute pancreatitis admissions. Patients with infected pancreatic necrosis or deteriorating sepsis had MIPN. Outcome parameters included necrotic volumes, conversion rate, morbidity, and mortality. Thirty patients were admitted with acute pancreatitis of which 15 required organ support. Twenty-nine necrosectomy sessions were performed. Average time from admission to necrosectomy was 39.7 days with an internecrosectomy interval of 6 to 14 days. Mean reduction of necrosis volume was 89.5% and postnecrosectomy volumes were variable. Mean length of hospital and intensive care unit stay was 124.3 and 40.2 days, respectively. Complications included bleeding, pancreatic fistula, and gastric outlet obstruction. No in-hospital deaths or conversions occurred. Frequent MIPN achieves substantial pancreatic bed volume reduction with no conversions. Repetitive tomographic scanning is of limited use as an indicator for renecrosectomy.