Severe acute pancreatitis: role for laparoscopic surgery

Abstract

Minimally invasive surgery is a new and promising treatment modality in the management of patients with severe acute pancreatitis (SAP). Aim of our study was the evaluation of our first experiences with laparoscopic surgery in the management of patients with SAP. A total of 65 patients complied with Atlanta recommendations for SAP and were included into this retrospective study. Indications for laparoscopic surgery were SAP presented with intraabdominal or retroperitoneal exudates and detected by ultrasound (US) and/or contrast enhanced computer tomography (CT) scan, and the presence of acute calculous cholecystitis when 3 to 5 days of conservative treatment did not show clinical improvement and surgical treatment was considered. Patients with improvement after initial therapy received conservative therapy only. Bacteriological cultures were done for abdominal exudates and necrotic tissue obtained during surgery. Totally, 39 patients were operated and 26 were treated conservatively only. Laparoscopic surgery was started in 31 patients and completed in 26 patients. The overall conversion rate was 16.1 %. Laparoscopic drainage of the intraabdominal exudate was done in 26 patients including drainage of the lesser sac in five of them. Laparoscopic cholecystectomy in 25 cases and laparoscopically assisted jejunostomy in 6 cases were performed as a part of the procedure. Conventional surgery was the primary procedure in 8 patients. Peripancreatic abscess formation was observed in one case one month after laparoscopic procedure and was cured with conventional surgical drainage. Bile leakage from the cystic stump was successfully treated with endoscopic papillotomy in one case. All patients survived after laparoscopic procedures. Overall complication rate was 7.7 % and mortality reached 3.1 %. Laparoscopic drainage of the abdominal cavity, drainage of the lesser sac and revision of the retroperitoneal compartment can be safely carried out as an alternative to the conventional surgical approach. Laparoscopic cholecystectomy and/or jejunostomy may be additionally performed if indicated.