Abstract
BackgroundLaparoscopic transgastric necrosectomy (LTGN) has been used in treatment of walled-off pancreatic necrosis (WON) for more than a decade. However, the safety and effectiveness of LTGN for WON with sinistral portal hypertension was still unclear.MethodsWON patients with sinistral portal hypertension treated in our department between January 2011 and December 2018 were included and retrospectively analyzed in this study. Patients were divided into two groups according to different surgical approaches, LTNG or laparoscopic assisted trans-lesser sac necrosectomy (LATLSN). Perioperative and long-term outcomes were compared between two groups.Results312 cases diagnosed with WON were screened and 53 were finally included in this study. Of the included patients, 21 and 32 cases were received LTGN and LATLSN, respectively. LTGN was associated with significantly lower morbidity than LATLSN (19.0% vs 46.9%, p = 0.04) and similar severe complication (Clavien–Dindo ≥ III) rate (12.5% vs 19.0%, p = 0.70). LTGN did not increase the rate of postoperative hemorrhage (9.5% vs 6.3%, p = 1.00) and mortality (9.5% vs 9.4%, p = 1.00). After 39 (11–108) months follow-up, the recurrence rate of WON and long-term complications were also comparable between groups.ConclusionFrom current data, LTGN was safe and effective in treatment of WON patients with sinistral portal hypertension in terms of short- and long-term outcomes.
Highlights
Surgical or endoscopic step-up debridement has been recommended as the standard therapy for necrotizing pancreatitis in terms of reducing short- and long-term complications when comparing with open surgery [1,2,3]
Cao et al BMC Surg (2021) 21:362 effectiveness, safety, short-term and long-term outcomes of this approach for walled-off pancreatic necrosis (WON) with sinistral portal hypertension were focused in this study
As necrosis confined to the lesser sac was the ideal indication for transgastric necrosectomy, we carefully re-checked the imaging of computed tomography or magnetic resonance
Summary
Surgical or endoscopic step-up debridement has been recommended as the standard therapy for necrotizing pancreatitis in terms of reducing short- and long-term complications when comparing with open surgery [1,2,3]. In the recent randomized clinical trials, endoscopic approach has been confirmed with lower rate of pancreatic fistulas and length of hospital stay and these results might result in a shift to the endoscopic management as. Cao et al BMC Surg (2021) 21:362 effectiveness, safety, short-term and long-term outcomes of this approach for walled-off pancreatic necrosis (WON) with sinistral portal hypertension were focused in this study. Laparoscopic transgastric necrosectomy (LTGN) has been used in treatment of walled-off pancreatic necrosis (WON) for more than a decade. The safety and effectiveness of LTGN for WON with sinistral portal hypertension was still unclear
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