Necrosectomía pancreatica laparoscópica

En el último tiempo se ha discutido bastante la posibilidad de realizar necrosectomías por vía laparóscopica en pacientes con pancreatitis aguda infectada. A continuación esta el resumen de un trabajo publicado en el Archives of Surgery que incluye 23 pacientes.

Laparoscopic-Assisted Pancreatic Necrosectomy
A New Surgical Option for Treatment of Severe Necrotizing Pancreatitis
Dilip Parekh, MD
Arch Surg. 2006;141:895-903.
Hypothesis Open surgery for pancreatic debridement is often associated with major morbidity such as wound complications, fascial dehiscence, and intestinal fistulae. Hand-assisted laparoscopic surgery (HALS) is useful for complex abdominal procedures since the benefits of traditional laparoscopic surgery are retained. Published experience with HALS for pancreatic debridement is limited to anecdotal case reports.
Setting University-affiliated private and public hospitals.
Patients Twenty-three patients with necrotizing pancreatitis were evaluated and 19 patients underwent pancreatic debridement from 2001 to 2006. A GelPort (Applied Medical, Rancho Santa Margarita, Calif) was used to provide laparoscopic hand access. In the majority of the patients, an infracolic approach was used to access the pancreatic necrosis.
Results Nineteen patients underwent laparoscopic evacuation of pancreatic necrosis, and in 18 patients, the procedure was completed. The mean age was 54 years; the mean ± SEM body mass index, calculated as weight in kilograms divided by height in meters squared, was 32.0 ± 2.6; the mean American Society of Anesthesiologists score was 3.4; and 7 of 19 patients had past history organ failure. The mean ± SEM operating time was 153 ± 10 minutes and mean ± SEM blood loss was 352.6 ± 103 mL. Four patients required reoperations, 2 using HALS and 2 open. There were no postoperative complications related to the HAL procedure itself, such as major wound infections, intestinal fistulae, or postoperative hemorrhage. Postoperative computed tomographic scans confirmed adequacy of debridement. The mean ± SEM length of hospital stay after surgery was 16.3 ± 3.8 days.

Conclusions This is the largest reported study of laparoscopic debridement for pancreatic necrosis. The procedure is feasible and associated with a low morbidity and mortality. Pancreatic debridement with HALS may provide a new option for the surgical treatment of selected patients with severe necrotizing pancreatitis.