Retroperitoneal Laparoscopic Debridement and Drainage for Pancreatic Abscess

The scope of our research is the surgical treatment of necrotizing pancreatitis. The questions we are trying to answer include how to drain abscesses around the pancreas in patients with the aim of controlling infections. The main challenge in our research currently lies in the successful establishment of the retroperitoneal passage, as well as interoperative bleeding that may result from the removal of necrotic tissue.

Compared to open and traditional laparoscopic surgery, our technique simplifies exposures of retroperitoneal organs, reduce the risk of injury to abdominal organs, and facilitates post-operative drainage. To begin administer intravenous antibiotics and proton pump inhibitors 30 minutes before anesthesia. After successful anesthesia, to set up the three-port trocar, using a scalpel create a two centimeter skin incision below the left axillary posterior line and rib margin.

Separate the subcutaneous tissue and muscles with fingers. Extend the fingers to push apart the lumbar fascia and peritoneum and widen the retroperitoneal space. Now install two 10 millimeter trocars and one five millimeter trocar at specific locations around the left iliac crest and midline.

Then inject carbon dioxide gas and maintain the gas pressure. Explore the retroperitoneal tissues laparoscopically using a sharp dissection method to clear pararenal fat tissue. Then employ an ultrasonic scalpel with dissecting forceps to expose the pararenal fascia.

Now use an ultrasonic scalpel to open the pararenal fascia on the lateral side of the peritoneal reflection. Employ a suction device and blunt dissection for accessing the pararenal space between the descending colon and left kidney. Then use bipolar electrocoagulation and an ultrasonic scalpel to prevent potential bleeding.

Next, incise the anterior renal fascia and expand the retroperitoneal front space of the kidney. Aspirate the pus. Enlarge the incision and enter the abscess cavity.

Then use tissue forceps to remove the black necrotic tissue from the abscess cavity. Afterward, rinse the cavity using hydrogen peroxide, povidone iodine, normal saline solution in sequence until the fluid appears relatively clear. For comprehensive hemostasis in the surgical area, place drainage tubes below and in front of the pancreas.

Confirm the absence of bleeding at the incision site. The postoperative CT scan showed a significant reduction in parapancreatic fluid accumulation and necrotic tissue. The white blood cell count, neutrophil ratio, and PCT were elevated in all six patients and their values significantly decreased one week after surgery.