LAPAROSCOPIC PANCREATIC NECROSECTOMY

      Acute necrotising pancreatitis is a condition in which there will be gross damage to the pancreas. One of the common causes is gall stone disease.  This pancreatic necrosis follows after biliary pancreatitis. There will be destruction of pancreatic tissue along with added infection. Most of the time acute pancreatitis is managed with medicines. Sometimes, this pancreatitis may end up with extensive pancreatic damage and may require the removal of the damaged (necrosed) part.

      Usually done with open surgery. But in stable and young patients, it can be done through laparoscopic technique. Usually, the patient requiring the necrosectomy will have pancreatitis induced systemic problems like kidney or respiratory problems. The extend of the pancreatic damage is evaluated by computerised tomography with intravenous contrast before starting the procedure. Once decided for laparoscopic procedure, anaesthesia evaluation is important. The procedure is done under general anaesthesia and three to four ports are introduced into the abdominal cavity. The gastrocolic ligament will be opened to assess the pancreas with infected necrosis. Identification of non-viable necrosed tissue is very important. The necrosed tissue will be soft, black in colour without blood flow. The advantage of the laparoscopic technique is that magnified view gives better visualisation of necrosed tissue and also necrosed tissue present away from the pancreatic tissue can also be accessed through this technique.    

      The actual necrosectomy depends on the site of pancreatic damage and extend of pancreatic damage. Pancreatic necrosectomy means removing the dead pancreatic tissue which is assessed during surgery by the blackish colour of the tissue with no blood flow in to that area. Once the dead tissue is removed, then clean wash is given and drains are placed. Sometimes, necrosectomy may not be possible with laparoscopy and in such situations the procedure is completed with open surgery.