Transgastric necrosectomy by open surgery in necrotising acute pancreatitis

Background: Conventional surgery for necrotising acute pancreatitis is often associated with high mortality and morbidity rates. The aim of this study was to describe the initial experience with a new and presumed lesser invasive surgical procedure.

Methods: The outcome of patients who underwent transgastric necrosectomy and subsequent marsupialisation due to necrotising pancreatitis was registered.

Results: Seven patients (five males, two females) with a median age of 47 years (range 32-62 years) had surgery. The reasons for pancreatitis were: gallstones (n = 4), idiopathic (n = 2) and alcohol (n = 1). The median time from onset of symptoms to surgery was 40 days (range 29-90 days). Four patients (57%) had an uneventful post-operative stay. Three patients (43%) had one or more complications requiring invasive therapy. Two of these patients needed repeated surgery. The median postoperative hospitalisation was 18 days (range 10-65 days). There was no post-operative mortality. At a three-month follow-up, one patient had exocrine pancreatic insufficiency, and one patient had both exocrine pancreatic insufficiency and diabetes mellitus.

Conclusions: Transgastric necrosectomy seems to be associated with a low risk of complications for selected patients with necrotising acute pancreatitis. However, further experience with the procedure is needed in order to draw valid conclusions.