Video-assisted retroperitoneal debridement of infected necrotizing pancreatitis: the first experience of P. Stradins Clinical University Hospital

The main objective of this article was to show the first experience in treating acute necrotizing infected pancreatitis using minimally invasive techniques in Pauls Stradins Clinical University Hospital. The strategy chosen by our hospital includes the so-called step-by-step approach, combining radiological and surgical techniques. Seven patients who underwent this procedure in Pauls Stradins Clinical University Hospital were selected and included in the study. A standardized strategy consisting of CT–guided puncture of necrotic collections, followed by implantation of a navigation drain was used in all cases. Afterwards a minimally invasive technique for draining necrotic collections – video assisted retroperitoneal debridement (VARD) – was performed. In total, 17 VARD operations were performed. An average of 3 operation per patient were required, which meets the standard of world practice. Four patients were discharged from the hospital without surgical complications but showing the development of pancreatogenic diabetes. One patient died due to a condition unrelated to the underlying disease. One patient died because of progression of the underlying disease, but not associated with surgical treatment. One patient was discharged and continues outpatient treatment. The VARD technique is a minimally invasive, innovative technique in the treatment of acute necrotizing infected pancreatitis. With appropriate patient preparation and the use of a step-by-step approach, it is possible to achieve significant improvement in patient's condition, in comparison to a conventional or conservative approach.