Walled-off Pancreatic Necrosis Treated with Video-Assisted Retroperitoneal Debridement (VARD)

Gustavo Adolfo Guerrero Martínez; Luis Gerardo Aguilera Muñoz; Maryel Sánchez Olvera

doi:doi:10.11648/j.js.20221005.11

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Walled-off Pancreatic Necrosis Treated with Video-Assisted Retroperitoneal Debridement (VARD)

Gustavo Adolfo Guerrero Martínez, Luis Gerardo Aguilera Muñoz, Maryel Sánchez Olvera

Published in Journal of Surgery (Volume 10, Issue 5)

Received: 21 March 2022 Accepted: 11 April 2022 Published: 29 September 2022

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Abstract

Acute pancreatitis is Pancreas inflamatory process that should be suspected in patients with severe acute abdominal pain in the upper quadrants, mainly in the epigastrium. However, to diagnose it, laboratory and imaging studies are necessary and two of the following criteria are required: abdominal pain consistent with the disease, serum amylase or lipase elevated more than three times the upper limit of normal and strongly suggestive images (US, CT, MRI). Up to 10-20% of cases of severe pancreatitis will develop necrosis of the gland and its peripheral tissues, generating a slow and torpid evolution with tendency to clinical deterioration, carrying the patient to mortality of up to 20-40% when associated with infection. In these cases, an invasive approach is mandatory in order to extract the fluid from inside the collection and/or necrotic tissue. Minimally invasive techniques such as percutaneous or endoscopic drainage, endoscopic necrosectomy, and video-assisted pancreatic necrosectomy (VARD) have been proposed, due to the high rate of morbidity and mortality that open necrosectomy carries; however, it is still used when minimally invasive management does not solves the problem. In this article we present the case of a 56-year-old patient with moderate acute pancreatitis of biliary origin, complicated by infected pancreatic necrosis, being managed with VARD, presenting an adequate postoperative evolution.

Published in	Journal of Surgery (Volume 10, Issue 5)
DOI	10.11648/j.js.20221005.11
Page(s)	144-148
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Acute Pancreatitis, Pancreatic Necrosis, Percutaneous Drainage, Necrosectomy, VARD, Minimally Invasive, Peripancreatic Collections

References

[1]	Velázquez de la Vega R, Cárdenas Lailson LE. Pancreatitis aguda y necrosis pancreática: conceptos actuales y tratamiento. Cirujano General. 2017; 39 (3): 147-51.
[2]	Ortiz Morales CM, Parlorio de Andrés E, Olalla Muñoz JR, Girela Baena JA, López Corbalán JA, Murcia ES. La clasificaciòn de Atlanta revisada en imágenes. En Congreso SERAM 2014; 2014.
[3]	Hackert T, Büchler MW. Decision Making in Necrotizing Pancreatitis. Dig Dis. 2016; 34 (5): 517-24.
[4]	H. Baron T, J. DiMaio C, Y. Wang A, a: Morgan K. American Gastroenterological Association Clinical Practice Update: Managment of Pancreatic Necrosis. AGA. 2020; 158: 66-75.
[5]	Sorrentino L, Chiara O, Mutignani M, Sammartano F, Brioschi P, Cimbanassi S. Combined totally mini-invasive approach in necrotizing pancreatitis: a case report and systematic literature review. World J Emerg Surg. diciembre de 2017; 12 (1): 16.
[6]	van Santvoort HC, Bakker OJ, Dejong CH, Schaapherder AF, Bollen TL, Nieuwenhuijs VB, et al. A Step-up Approach or Open Necrosectomy for Necrotizing Pancreatitis. The New England Journal of Medicine. 2010; 12.
[7]	Logue JA, Carter CR. Minimally Invasive Necrosectomy Techniques in Severe Acute Pancreatitis: Role of Percutaneous Necrosectomy and Video-Assisted Retroperitoneal Debridement. Gastroenterology Research and Practice. 2015; 2015: 1-6.
[8]	John BJ, Swaminathan S, VenkataKrishnan L, Singh GS, Krishnaveni G, Mohandas N, et al. Management of Infected Pancreatic Necrosis—The “Step Up” Approach and Minimal Access Retroperitoneal Pancreatic Necrosectomy. Indian J Surg. abril de 2015; 77 (S1): 125-7.
[9]	The Dutch Pancreatitis Study Group, van Brunschot S, van Grinsven J, Voermans RP, Bakker OJ, Besselink MG, et al. Transluminal endoscopic step-up approach versus minimally invasive surgical step-up approach in patients with infected necrotising pancreatitis (TENSION trial): design and rationale of a randomised controlled multicenter trial [ISRCTN09186711]. BMC Gastroenterol. diciembre de 2013; 13 (1): 161.
[10]	Dalsania R, Willingham FF. Treatment of walled-off pancreatic necrosis. Current Opinion in Gastroenterology. septiembre de 2019; 35 (5): 478-82.
[11]	Zhang J, Sun B. Comparison between video-assisted retroperitoneal debridement and small incision pancreatic necrosectomy in infected pancreatic necrosis. ANZ Journal of Surgery. octubre de 2020; 90 (10): 2020-5.
[12]	Bendersky V, Mallipeddi M, Perez A, Pappas T. Necrotizing pancreatitis: challenges and solutions. CEG. octubre de 2016; Volume 9: 345-50.
[13]	Karakayali FY. Surgical and interventional management of complications caused by acute pancreatitis. WJG. 2014; 20 (37): 13412.
[14]	Sánchez-Gálvez MÁ, Martínez-Baena D, Parra-Membrives P, Jiménez-Riera G, Lorente-Herce JM. Video-assisted retroperitoneal debridement (VARD). 2018; 3.
[15]	Hollemans RA, van Brunschot S, Bakker OJ, Bollen TL, Timmer R, Besselink MG, et al. Minimally invasive intervention for infected necrosis in acute pancreatitis. Expert Review of Medical Devices. noviembre de 2014; 11 (6): 637-48.
[16]	Fagenholz PJ, Thabet A, Mueller PR, Forcione DG. Combined endoscopic trangastric drainage and video assisted retroperitoneal pancreatic debridement – The best of both worlds for extensive pancreatic necrosis with enteric fistulae. Pancreatology. septiembre de 2016; 16 (5): 788-90.

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APA Style

Gustavo Adolfo Guerrero Martínez, Luis Gerardo Aguilera Muñoz, Maryel Sánchez Olvera. (2022). Walled-off Pancreatic Necrosis Treated with Video-Assisted Retroperitoneal Debridement (VARD). Journal of Surgery, 10(5), 144-148. https://doi.org/10.11648/j.js.20221005.11

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ACS Style

Gustavo Adolfo Guerrero Martínez; Luis Gerardo Aguilera Muñoz; Maryel Sánchez Olvera. Walled-off Pancreatic Necrosis Treated with Video-Assisted Retroperitoneal Debridement (VARD). J. Surg. 2022, 10(5), 144-148. doi: 10.11648/j.js.20221005.11

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AMA Style

Gustavo Adolfo Guerrero Martínez, Luis Gerardo Aguilera Muñoz, Maryel Sánchez Olvera. Walled-off Pancreatic Necrosis Treated with Video-Assisted Retroperitoneal Debridement (VARD). J Surg. 2022;10(5):144-148. doi: 10.11648/j.js.20221005.11

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@article{10.11648/j.js.20221005.11,
  author = {Gustavo Adolfo Guerrero Martínez and Luis Gerardo Aguilera Muñoz and Maryel Sánchez Olvera},
  title = {Walled-off Pancreatic Necrosis Treated with Video-Assisted Retroperitoneal Debridement (VARD)},
  journal = {Journal of Surgery},
  volume = {10},
  number = {5},
  pages = {144-148},
  doi = {10.11648/j.js.20221005.11},
  url = {https://doi.org/10.11648/j.js.20221005.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20221005.11},
  abstract = {Acute pancreatitis is Pancreas inflamatory process that should be suspected in patients with severe acute abdominal pain in the upper quadrants, mainly in the epigastrium. However, to diagnose it, laboratory and imaging studies are necessary and two of the following criteria are required: abdominal pain consistent with the disease, serum amylase or lipase elevated more than three times the upper limit of normal and strongly suggestive images (US, CT, MRI). Up to 10-20% of cases of severe pancreatitis will develop necrosis of the gland and its peripheral tissues, generating a slow and torpid evolution with tendency to clinical deterioration, carrying the patient to mortality of up to 20-40% when associated with infection. In these cases, an invasive approach is mandatory in order to extract the fluid from inside the collection and/or necrotic tissue. Minimally invasive techniques such as percutaneous or endoscopic drainage, endoscopic necrosectomy, and video-assisted pancreatic necrosectomy (VARD) have been proposed, due to the high rate of morbidity and mortality that open necrosectomy carries; however, it is still used when minimally invasive management does not solves the problem. In this article we present the case of a 56-year-old patient with moderate acute pancreatitis of biliary origin, complicated by infected pancreatic necrosis, being managed with VARD, presenting an adequate postoperative evolution.},
 year = {2022}
}

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TY  - JOUR
T1  - Walled-off Pancreatic Necrosis Treated with Video-Assisted Retroperitoneal Debridement (VARD)
AU  - Gustavo Adolfo Guerrero Martínez
AU  - Luis Gerardo Aguilera Muñoz
AU  - Maryel Sánchez Olvera
Y1  - 2022/09/29
PY  - 2022
N1  - https://doi.org/10.11648/j.js.20221005.11
DO  - 10.11648/j.js.20221005.11
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 144
EP  - 148
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20221005.11
AB  - Acute pancreatitis is Pancreas inflamatory process that should be suspected in patients with severe acute abdominal pain in the upper quadrants, mainly in the epigastrium. However, to diagnose it, laboratory and imaging studies are necessary and two of the following criteria are required: abdominal pain consistent with the disease, serum amylase or lipase elevated more than three times the upper limit of normal and strongly suggestive images (US, CT, MRI). Up to 10-20% of cases of severe pancreatitis will develop necrosis of the gland and its peripheral tissues, generating a slow and torpid evolution with tendency to clinical deterioration, carrying the patient to mortality of up to 20-40% when associated with infection. In these cases, an invasive approach is mandatory in order to extract the fluid from inside the collection and/or necrotic tissue. Minimally invasive techniques such as percutaneous or endoscopic drainage, endoscopic necrosectomy, and video-assisted pancreatic necrosectomy (VARD) have been proposed, due to the high rate of morbidity and mortality that open necrosectomy carries; however, it is still used when minimally invasive management does not solves the problem. In this article we present the case of a 56-year-old patient with moderate acute pancreatitis of biliary origin, complicated by infected pancreatic necrosis, being managed with VARD, presenting an adequate postoperative evolution.
VL  - 10
IS  - 5
ER  -

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Author Information

Gustavo Adolfo Guerrero Martínez

General Surgery Service, Hospital Regional ISSSTE, Puebla, Mexico
Luis Gerardo Aguilera Muñoz
Maryel Sánchez Olvera

General Surgery Service, Hospital Regional ISSSTE, Puebla, Mexico

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Plain Text BibTeX RIS

APA Style

Gustavo Adolfo Guerrero Martínez, Luis Gerardo Aguilera Muñoz, Maryel Sánchez Olvera. (2022). Walled-off Pancreatic Necrosis Treated with Video-Assisted Retroperitoneal Debridement (VARD). Journal of Surgery, 10(5), 144-148. https://doi.org/10.11648/j.js.20221005.11

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ACS Style

Gustavo Adolfo Guerrero Martínez; Luis Gerardo Aguilera Muñoz; Maryel Sánchez Olvera. Walled-off Pancreatic Necrosis Treated with Video-Assisted Retroperitoneal Debridement (VARD). J. Surg. 2022, 10(5), 144-148. doi: 10.11648/j.js.20221005.11

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AMA Style

Gustavo Adolfo Guerrero Martínez, Luis Gerardo Aguilera Muñoz, Maryel Sánchez Olvera. Walled-off Pancreatic Necrosis Treated with Video-Assisted Retroperitoneal Debridement (VARD). J Surg. 2022;10(5):144-148. doi: 10.11648/j.js.20221005.11

Copy | Download

@article{10.11648/j.js.20221005.11,
  author = {Gustavo Adolfo Guerrero Martínez and Luis Gerardo Aguilera Muñoz and Maryel Sánchez Olvera},
  title = {Walled-off Pancreatic Necrosis Treated with Video-Assisted Retroperitoneal Debridement (VARD)},
  journal = {Journal of Surgery},
  volume = {10},
  number = {5},
  pages = {144-148},
  doi = {10.11648/j.js.20221005.11},
  url = {https://doi.org/10.11648/j.js.20221005.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20221005.11},
  abstract = {Acute pancreatitis is Pancreas inflamatory process that should be suspected in patients with severe acute abdominal pain in the upper quadrants, mainly in the epigastrium. However, to diagnose it, laboratory and imaging studies are necessary and two of the following criteria are required: abdominal pain consistent with the disease, serum amylase or lipase elevated more than three times the upper limit of normal and strongly suggestive images (US, CT, MRI). Up to 10-20% of cases of severe pancreatitis will develop necrosis of the gland and its peripheral tissues, generating a slow and torpid evolution with tendency to clinical deterioration, carrying the patient to mortality of up to 20-40% when associated with infection. In these cases, an invasive approach is mandatory in order to extract the fluid from inside the collection and/or necrotic tissue. Minimally invasive techniques such as percutaneous or endoscopic drainage, endoscopic necrosectomy, and video-assisted pancreatic necrosectomy (VARD) have been proposed, due to the high rate of morbidity and mortality that open necrosectomy carries; however, it is still used when minimally invasive management does not solves the problem. In this article we present the case of a 56-year-old patient with moderate acute pancreatitis of biliary origin, complicated by infected pancreatic necrosis, being managed with VARD, presenting an adequate postoperative evolution.},
 year = {2022}
}

Copy | Download

TY  - JOUR
T1  - Walled-off Pancreatic Necrosis Treated with Video-Assisted Retroperitoneal Debridement (VARD)
AU  - Gustavo Adolfo Guerrero Martínez
AU  - Luis Gerardo Aguilera Muñoz
AU  - Maryel Sánchez Olvera
Y1  - 2022/09/29
PY  - 2022
N1  - https://doi.org/10.11648/j.js.20221005.11
DO  - 10.11648/j.js.20221005.11
T2  - Journal of Surgery
JF  - Journal of Surgery
JO  - Journal of Surgery
SP  - 144
EP  - 148
PB  - Science Publishing Group
SN  - 2330-0930
UR  - https://doi.org/10.11648/j.js.20221005.11
AB  - Acute pancreatitis is Pancreas inflamatory process that should be suspected in patients with severe acute abdominal pain in the upper quadrants, mainly in the epigastrium. However, to diagnose it, laboratory and imaging studies are necessary and two of the following criteria are required: abdominal pain consistent with the disease, serum amylase or lipase elevated more than three times the upper limit of normal and strongly suggestive images (US, CT, MRI). Up to 10-20% of cases of severe pancreatitis will develop necrosis of the gland and its peripheral tissues, generating a slow and torpid evolution with tendency to clinical deterioration, carrying the patient to mortality of up to 20-40% when associated with infection. In these cases, an invasive approach is mandatory in order to extract the fluid from inside the collection and/or necrotic tissue. Minimally invasive techniques such as percutaneous or endoscopic drainage, endoscopic necrosectomy, and video-assisted pancreatic necrosectomy (VARD) have been proposed, due to the high rate of morbidity and mortality that open necrosectomy carries; however, it is still used when minimally invasive management does not solves the problem. In this article we present the case of a 56-year-old patient with moderate acute pancreatitis of biliary origin, complicated by infected pancreatic necrosis, being managed with VARD, presenting an adequate postoperative evolution.
VL  - 10
IS  - 5
ER  -

Copy | Download