Background: Minimally invasive necrosectomy through a retroperitoneal approach is gaining popularity in the treatment of necrotizing pancreatitis. There is, however, no substantial evidence from comparative studies in favour of this technique over laparotomy. The aim of this case-matched study was to perform the first head-to-head comparison of necrosectomy by the retroperitoneal approach with laparotomy in necrotizing pancreatitis.
Methods: Between 2001 and 2005, 15 out of 841 consecutive acute pancreatitis patients underwent necrosectomy by the retroperitoneal approach using a small flank incision. These patients were matched for presence of preoperative organ failure, status of infection, timing of surgery, age and computed tomography severity index (CTSI)-score with 15 out of 46 patients treated with laparotomy and continuous postoperative lavage (CPL).
Results: In addition to all matched preoperative characteristics, there were no significant differences in gender, preoperative ICU-admission, preoperative ICU-stay, preoperative APACHE-II scores and preoperative multiple organ failure. Postoperative complications requiring reintervention occurred in 6 patients in each group (P = 1.000). Postoperative new onset multiple organ failure occurred in 9 patients in the laparotomy/CPL group versus 2 patients in the retroperitoneal approach group (P = 0.021). In the laparotomy/CPL group 6 patients died versus 1 patient in the retroperitoneal approach group (P = 0.080).
Conclusions: Although no difference in postoperative complication rate was observed, the less postoperative organ failure and the trend towards lower mortality may point towards a benefit of the retroperitoneal approach over laparotomy. A randomized controlled design is required.