The optimal management of necrotizing pancreatitis continues to evolve. Currently, conservative intensive care treatment represents the primary therapy of acute severe necrotizing pancreatitis, aiming at prevention of organ failure. Following this mode of treatment most patients with sterile necroses can be managed successfully. Surgery might be considered as an option in the late phase of the disease for patients with proven infected pancreatic necroses and organ failure. For these patients surgical debridement is still considered the treatment of choice. However, even for this subgroup of patients, the concept of operative strategy has been recently challenged. Nowadays, it is generally accepted that necrotizing pancreatitis with proven infected necroses as well as septic complications directly caused by pancreatic infection are strong indications for surgical management. However, the question of the most appropriate surgical technique for the treatment of pancreatic necroses remains unsettled. At the same time, recent advances in radiological imaging, new developments in interventional radiology, and other minimal access interventions have revolutionised the management of necrotizing pancreatitis. In light of these controversies, the present paper will focus on the current role of surgery in terms of open necrosectomy in the management of severe acute necrotizing pancreatitis. 1. Introduction Despite the considerable progress in the knowledge of the natural course and pathophysiology of acute pancreatitis (AP), the underlying pathogenetic mechanisms acting during the course of the disease, leading to acinus cell necroses and propagation of necrotizing inflammation, are still to a large extent undefined [1–4]. In the majority of cases, AP comprises clinically a mild transitory form of oedematous-interstitial inflammation, which is self-limiting and resolves spontaneously. However, 15%–20% of patients with AP will develop the more severe form of the disease [5]. Such patients will initially exhibit a hypovolemic state or even shock, followed by fluid sequestration into the pancreas, peripancreatic areas, and intra- and extraperitoneal spaces [6]. The subsequent systemic hyperinflammation may lead to organ dysfunction and/or local complications, such as pancreatic necrosis (PN) and formation of intra-abdominal abscesses and/or pseudocysts [7, 8]. Primary therapy of severe necrotizing pancreatitis (SNP) consists of a conservative intensive care treatment, aiming at fluid replacement, sufficient analgesia, and prevention of organ failure. Clinical
References
[1]
E. Klar and J. Werner, “New pathophysiological findings on acute pancreatitis,” Chirurg, vol. 71, no. 3, pp. 253–264, 2000.
[2]
R. Isenmann and H. G. Beger, “Natural history of acute pancreatitis and the role of infection,” Bailliere's Best Practice in Clinical Gastroenterology, vol. 13, no. 2, pp. 291–301, 1999.
[3]
M. Büchler, P. Malfertheiner, H. Friess et al., “The penetration of antibiotics into human pancreas,” Infection, vol. 17, no. 1, pp. 20–25, 1989.
[4]
M. Büchler, P. Malfertheiner, H. Schadlich, T. J. Nevalainen, H. Friess, and H. G. Beger, “Role of phospholipase A2 in human acute pancreatitis,” Gastroenterology, vol. 97, no. 6, pp. 1521–1526, 1989.
[5]
W. Uhl, M. Büchler, P. Malfertheiner, R. Isenmann, M. Martini, and H. G. Beger, “Pancreatic necrosis develops within four days after the acute attack,” Gastroenterology, vol. 100, p. A123, 1991.
[6]
I. A. Al Mofleh, “Acute pancreatitis,” Saudi Journal of Gastroenterology, vol. 3, pp. 113–120, 1997.
[7]
L. C. Carey, “Extra-abdominal manifestations of acute pancreatitis,” Surgery, vol. 86, no. 2, pp. 337–342, 1979.
[8]
D. W. McFadden, “Organ failure and multiple organ system failure in pancreatitis,” Pancreas, vol. 6, no. 1, pp. S37–S43, 1991.
[9]
J. Werner, S. Feuerbach, W. Uhl, and M. W. Büchler, “Management of acute pancreatitis: from surgery to interventional intensive care,” Gut, vol. 54, no. 3, pp. 426–436, 2005.
[10]
C. Dervenis, C. D. Johnson, C. Bassi et al., “Diagnosis, objective assessment of severity, and management of acute pancreatitis: santorini consensus conference,” International Journal of Pancreatology, vol. 25, no. 3, pp. 195–210, 1999.
[11]
W. Uhl, A. Warshaw, C. Imrie et al., “IAP guidelines for the surgical management of acute pancreatitis,” Pancreatology, vol. 2, no. 6, pp. 565–573, 2002.
[12]
“United Kingdom guidelines for the management of acute pancreatitis,” Gut, vol. 42, pp. 1–13, 1998.
[13]
M. W. Büchler, B. Gloor, C. A. Müller, H. Friess, C. A. Seiler, and W. Uhl, “Acute necrotizing pancreatitis: treatment strategy according to the status of infection,” Annals of Surgery, vol. 232, pp. 619–626, 2000.
[14]
E. L. Bradley III, “Indications for debridement of necrotizing pancreatitis,” Pancreas, vol. 13, no. 3, pp. 219–223, 1996.
[15]
C. Bassi, M. Larvin, and E. Villatoro, “Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis,” Cochrane Database of Systematic Reviews, no. 4, article CD002941, 2003.
[16]
C. Bassi, G. Butturini, M. Falconi, R. Salvia, I. Frigerio, and P. Pederzoli, “Outcome of open necrosectomy in acute pancreatitis,” Pancreatology, vol. 3, no. 2, pp. 128–132, 2003.
[17]
D. W. McFadden and H. A. Reber, “Indications for surgery in severe acute pancreatitis,” International Journal of Pancreatology, vol. 15, no. 2, pp. 83–90, 1994.
[18]
J. H. Ranson, “The current management of acute pancreatitis,” Advances in surgery, vol. 28, pp. 93–112, 1995.
[19]
E. L. Bradley III, “A fifteen year experience with open drainage for infected pancreatic necrosis,” Surgery Gynecology and Obstetrics, vol. 177, no. 3, pp. 215–222, 1993.
[20]
K. Bosscha, P. F. Hulstaert, A. Hennipman et al., “Fulminant acute pancreatitis and infected necrosis: Results of open management of the abdomen and “planned” reoperations,” Journal of the American College of Surgeons, vol. 187, no. 3, pp. 255–262, 1998.
[21]
V. B. Nieuwenhuijs, M. G. H. Besselink, L. P. van Minnen, and H. G. Gooszen, “Surgical management of acute necrotizing pancreatitis: a 13-year experience and a systematic review,” Scandinavian Journal of Gastroenterology, vol. 38, no. 239, pp. 111–116, 2003.
[22]
T. J. Howard, J. B. Patel, N. Zyromski et al., “Declining morbidity and mortality rates in the surgical management of pancreatic necrosis,” Journal of Gastrointestinal Surgery, vol. 11, no. 1, pp. 43–49, 2007.
[23]
M. G. Sarr, D. M. Nagorney, P. Mucha Jr., M. B. Farnell, and C. D. Johnson, “Acute necrotizing pancreatitis: management by planned, staged pancreatic necrosectomy/debridement and delayed primary wound closure over drains,” British Journal of Surgery, vol. 78, no. 5, pp. 576–581, 1991.
[24]
G. G. Tsiotos, E. Luque-de León, and M. G. Sarr, “Long-term outcome of necrotizing pancreatitis treated by necrosectomy,” British Journal of Surgery, vol. 85, no. 12, pp. 1650–1653, 1998.
[25]
C. Fernandez-del Castillo, D. W. Rattner, M. A. Makary, A. Mostafavi, D. McGrath, and A. L. Warshaw, “Débridement and closed packing for the treatment of necrotizing pancreatitis,” Annals of Surgery, vol. 228, no. 5, pp. 676–684, 1998.
[26]
J. R. Rodriguez, A. O. Razo, J. Targarona et al., “Debridement and closed packing for sterile or infected necrotizing pancreatitis: insights into indications and outcomes in 167 patients,” Annals of Surgery, vol. 247, no. 2, pp. 294–299, 2008.
[27]
H. G. Beger, M. Büchler, R. Bittner, S. Block, T. Nevalainen, and R. Roscher, “Necrosectomy and postoperative local lavage in necrotizing pancreatitis,” British Journal of Surgery, vol. 75, no. 3, pp. 207–212, 1988.
[28]
G. Farkas, J. Márton, Y. Mándi, and L. Leindler, “Surgical management and complex treatment of infected pancreatic necrosis: 18-Year experience at a single center,” Journal of Gastrointestinal Surgery, vol. 10, no. 2, pp. 278–285, 2006.
[29]
H. C. van Santvoort, M. G. Besselink, O. J. Bakker, et al., “Dutch Pancreatitis Study Group. A step-up approach or open necrosectomy for necrotizing pancreatitis,” The New England Journal of Medicine, vol. 362, pp. 1491–1502, 2010.
[30]
D. Heath, D. Alexander, C. Wilson, M. Larvin, C. Imrie, and M. McMahon, “Which complications of acute pancreatitis are most lethal? A prospective multicenter clinical study of 719 episodes,” Gut, vol. 36, p. 478, 1995.
[31]
J. P. Neoptolemos, M. Raraty, M. Finch, and R. Sutton, “Acute pancreatitis: the substantial human and financial costs,” Gut, vol. 42, no. 6, pp. 886–891, 1998.
[32]
I. G. Renner, W. T. Savage, J. L. Pantoja, and V. J. Renner, “Death due to acute pancreatitis. A retrospective analysis of 405 autopsy cases,” Digestive Diseases and Sciences, vol. 30, no. 10, pp. 1005–1018, 1985.
[33]
D. J. Deziel and A. Doolas, “Pancreatic abscess and pancreatic necrosis: current concepts and controversies,” Problems in General Surgery, vol. 7, no. 3, pp. 415–427, 1990.
[34]
S. G. Gerzof, P. A. Banks, A. H. Robbins et al., “Early diagnosis of pancreatic infection by computed tomography-guided aspiration,” Gastroenterology, vol. 93, no. 6, pp. 1315–1320, 1987.
[35]
P. A. Banks, S. G. Gerzof, R. E. Langevin, S. G. Silverman, G. T. Sica, and M. D. Hughes, “CT-guided aspiration of suspected pancreatic infection: bacteriology and clinical outcome,” International Journal of Pancreatology, vol. 18, no. 3, pp. 265–270, 1995.
[36]
B. Rau, U. Pralle, J. M. Mayer, and H. G. Beger, “Role of ultrasonographically guided fine-needle aspiration cytology in the diagnosis of infected pancreatic necrosis,” British Journal of Surgery, vol. 85, no. 2, pp. 179–184, 1998.
[37]
A. L. Widdison and N. D. Karanjia, “Pancreatic infection complicating acute pancreatitis,” British Journal of Surgery, vol. 80, no. 2, pp. 148–154, 1993.
[38]
R. H. Fitz, “Acute pancreatitis: a consideration of pancreatic hemorrhage, hemorrhagic, suppurative and gangrenous pancreatitis and of disseminated fat necrosis,” The Boston Medical and Surgical Journal, vol. 70, pp. 181–235, 1889.
[39]
R. Elman, N. Arneson, and E. A. Graham, “Value of blood amylase estimations in the diagnosis of pancreatic disease: a clinical study,” Archives of Surgery, vol. 19, pp. 943–967, 1929.
[40]
J. R. Paxton and J. H. Payne, “Acute pancreatitis: a statistical review of 307 established cases of acute pancreatitis,” Surgery, Gynecology & Obstetrics, vol. 86, pp. 69–75, 1948.
[41]
E. F. Lewison, “Acute pancreatitis,” Archives of Surgery, vol. 41, pp. 1008–1037, 1940.
[42]
A. V. Pollock, “Acute pancreatitis; analysis of 100 patients,” British medical journal, vol. 1, no. 5113, pp. 6–14, 1959.
[43]
J. E. Trapnell, “The natural history and prognosis of acute pancreatitis,” Annals of the Royal College of Surgeons of England, vol. 38, no. 5, pp. 265–287, 1966.
[44]
G. T. Watts, “Total pancreatectomy for fulminant pancreatitis,” The Lancet, vol. 282, no. 7304, p. 384, 1963.
[45]
J. H. Alexandre and M. T. Guerrieri, “Role of total pancreatectomy in the treatment of necrotizing pancreatitis,” World Journal of Surgery, vol. 5, no. 3, pp. 369–377, 1981.
[46]
M. C. McCarthy and R. M. Dickerman, “Surgical management of severe acute pancreatitis,” Archives of Surgery, vol. 117, no. 4, pp. 476–480, 1982.
[47]
E. Kivilaakso, M. Lempinen, and A. Makelainen, “Pancreatic resection versus peritoneal lavation for acute fulminant pancreatitis. A randomized prospective study,” Annals of Surgery, vol. 199, no. 4, pp. 426–431, 1984.
[48]
M. C. Aldridge, M. Ornstein, G. Glazer, and H. A. F. Dudley, “Pancreatic resection for severe acute pancreatitis,” British Journal of Surgery, vol. 72, pp. 796–800, 1985.
[49]
I. Nordback, O. Auvinen, T. Pessi, and V. Autio, “Complications after pancreatic resection for acute necrotizing pancreatitis,” Acta Chirurgica Scandinavica, vol. 152, no. 1, pp. 49–54, 1986.
[50]
O. Teerenhovi, I. Nordback, and J. Eskola, “High volume lesser sac lavage in acute necrotizing pancreatitis,” British Journal of Surgery, vol. 76, no. 4, pp. 370–373, 1989.
[51]
S. Block, W. Maier, and R. Bittner, “Identification of pancreas necrosis in severe acute pancreatitis: Imaging procedures versus clinical staging,” Gut, vol. 27, no. 9, pp. 1035–1042, 1986.
[52]
L. Leger, B. Chiche, and A. Louvel, “Pancreatic necrosis and acute pancreatitis,” World Journal of Surgery, vol. 5, no. 3, pp. 315–317, 1981.
[53]
H. G. Beger, W. Krautzberger, and R. Bittner, “Results of surgical treatment of necrotizing pancreatitis,” World Journal of Surgery, vol. 9, no. 6, pp. 972–979, 1985.
[54]
H. G. Beger, R. Bittner, S. Block, and M. Büchler, “Bacterial contamination of pancreatic necrosis. A prospective clinical study,” Gastroenterology, vol. 91, no. 2, pp. 433–438, 1986.
[55]
I. Poves Prim, J. Fabregat Prous, F. J. García Borobia, R. Jorba Martí, J. Figueras Felip, and E. Jaurrieta Mas, “Early onset of organ failure is the best predictor of mortality in acute pancreatitis,” Revista Espanola de Enfermedades Digestivas, vol. 96, no. 10, pp. 705–713, 2004.
[56]
B. M. Rau, A. Bothe, M. Kron, and H. G. Beger, “Role of early multisystem organ failure as major risk factor for pancreatic infections and death in severe acute pancreatitis,” Clinical Gastroenterology and Hepatology, vol. 4, no. 8, pp. 1053–1061, 2006.
[57]
A. Buter, C. W. Imrie, C. R. Carter, S. Evans, and C. J. McKay, “Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis,” British Journal of Surgery, vol. 89, no. 3, pp. 298–302, 2002.
[58]
C. D. Johnson and M. Abu-Hilal, “Persistent organ failure during the first week as a marker of fatal outcome in acute pancreatitis,” Gut, vol. 53, no. 9, pp. 1340–1344, 2004.
[59]
R. Orlando III, J. P. Welch, C. M. Akbari, G. P. Bloom, and W. P. Macaulay, “Techniques and complications of open packing of infected pancreatic necrosis,” Surgery Gynecology and Obstetrics, vol. 177, no. 1, pp. 65–71, 1993.
[60]
P. G？tzinger, T. Sautner, S. Kriwanek et al., “Surgical treatment for severe acute pancreatitis: extent and surgical control of necrosis determine outcome,” World Journal of Surgery, vol. 26, no. 4, pp. 474–478, 2002.
[61]
M. Larvin, A. G. Chalmers, P. J. Robinson, and M. J. McMahon, “Debridement and closed cavity irrigation for the treatment of pancreatic necrosis,” British Journal of Surgery, vol. 76, no. 5, pp. 465–471, 1989.
[62]
P. Pederzoli, C. Bassi, S. Vesentini et al., “Necrosectomy by lavage in the surgical treatment of severe necrotizing pancreatitis. Results in 263 patients,” Acta Chirurgica Scandinavica, vol. 156, no. 11-12, pp. 775–780, 1990.
[63]
J. J. de Waele, U. J. Hesse, P. Pattyn, J. Decruyenaere, and B. de Hemptinne, “Postoperative lavage and on demand surgical intervention in the treatment of acute necrotizing pancreatitis,” Acta Chirurgica Belgica, vol. 100, no. 1, pp. 16–20, 2000.
[64]
J. D. Wig, S. R. Mettu, R. Jindal, R. Gupta, and T. D. Yadav, “Closed lesser sac lavage in the management of pancreatic necrosis,” Journal of Gastroenterology and Hepatology, vol. 19, no. 9, pp. 1010–1015, 2004.
[65]
B. Rau, A. Bothe, and H. G. Beger, “Surgical treatment of necrotizing pancreatitis by necrosectomy and closed lavage: changing patient characteristics and outcome in a 19-year, single-center series,” Surgery, vol. 138, no. 1, pp. 28–39, 2005.
[66]
C. Wilson, C. S. McArdle, D. C. Carter, and C. W. Imrie, “Surgical treatment of acute necrotizing pancreatitis,” British Journal of Surgery, vol. 75, no. 11, pp. 1119–1123, 1988.
[67]
A. S. Villazon, O. D. Villazon, F. E. Terrazas, and R. G. Rana, “Retroperitoneal drainage in the management of the septic phase of severe acute pancreatitis,” World Journal of Surgery, vol. 15, no. 1, pp. 103–108, 1991.
[68]
D. Oleynikov, C. Cook, B. Sellers, M. C. Mone, and R. Barton, “Decreased mortality from necrotizing pancreatitis,” American Journal of Surgery, vol. 176, no. 6, pp. 648–653, 1998.
[69]
E. Kivilaakso, O. Fr？ki, P. Nikki, and M. Lempinen, “Resection of the pancreas for acute fulminant pancreatitis,” Surgery Gynecology and Obstetrics, vol. 152, no. 4, pp. 493–498, 1981.
[70]
L. Fernández-Cruz, S. Navarro, R. Valderrama, et al., “Acute necrotizing pancreatitis: a multicenter study,” Hepatogastroenterology, vol. 41, pp. 185–189, 1994.
[71]
E. L. Bradley III and K. Allen, “A prospective longitudinal study of observation versus surgical intervention in the management of necrotizing pancreatitis,” American Journal of Surgery, vol. 161, no. 1, pp. 19–25, 1991.
[72]
S. W. Ashley, A. Perez, E. A. Pierce et al., “Necrotizing pancreatitis: contemporary analysis of 99 consecutive cases,” Annals of Surgery, vol. 234, no. 4, pp. 572–580, 2001.
[73]
T. Foitzik, E. Klar, H. J. Buhr, and C. Herfarth, “Improved survival in acute necrotizing pancreatitis despite limiting the indications for surgical debridement,” European Journal of Surgery, Acta Chirurgica, vol. 161, no. 3, pp. 187–192, 1995.
[74]
M. Rünzi, W. Niebel, H. Goebell, G. Gerken, and P. Layer, “Severe acute pancreatitis: nonsurgical treatment of infected necroses,” Pancreas, vol. 30, no. 3, pp. 195–199, 2005.
[75]
K. Ayub, R. Imada, and J. Slavin, “Endoscopic retrograde cholangiopancreatography in gallstone-associated acute pancreatitis,” Cochrane Database of Systematic Reviews, no. 4, article CD003630, 2004.
[76]
Z. Hazem, “Acute biliary pancreatitis: diagnosis and treatment,” Saudi Journal of Gastroenterology, vol. 15, no. 3, pp. 147–155, 2009.
[77]
T. Mazaki, Y. Ishii, and T. Takayama, “Meta-analysis of prophylactic antibiotic use in acute necrotizing pancreatitis,” British Journal of Surgery, vol. 93, no. 6, pp. 674–684, 2006.
[78]
J. J. De Waele, S. I. Blot, D. Vogelaers, and F. Colardyn, “High infection rates in patients with severe acute necrotizing pancreatitis,” Intensive Care Medicine, vol. 30, no. 6, p. 1248, 2004.
[79]
J. J. de Waele, D. Vogelaers, S. Blot, and F. Colardyn, “Fungal infections in patients with severe acute pancreatitis and the use of prophylactic therapy,” Clinical Infectious Diseases, vol. 37, no. 2, pp. 208–213, 2003.
[80]
M. G. H. Besselink, T. J. Verwer, E. J. P. Schoenmaeckers et al., “Timing of surgical intervention in necrotizing pancreatitis,” Archives of Surgery, vol. 142, no. 12, pp. 1194–1201, 2007.
[81]
J. Mayer, B. Rau, F. Gansauge, and H. G. Beger, “Inflammatory mediators in human acute pancreatitis: clinical and pathophysiological implications,” Gut, vol. 47, no. 4, pp. 546–552, 2000.
[82]
T. L. Dugernier, P. F. Laterre, X. Wittebole et al., “Compartmentalization of the inflammatory response during acute pancreatitis: correlation with local and systemic complications,” American Journal of Respiratory and Critical Care Medicine, vol. 168, no. 2, pp. 148–157, 2003.
[83]
M. Büchler, S. Block, W. Krautzberger, R. Bittner, and H. G. Beger, “Necrotizing pancreatitis: peritoneal lavage or bursa lavage? Results of a prospective consecutive controlled study.,” Chirurg, vol. 56, pp. 247–250, 1985.
[84]
C. Gebhardt and F. P. Gall, “Importance of peritoneal irrigation after surgical treatment of hemorrhagic, necrotizing pancreatitis,” World Journal of Surgery, vol. 5, no. 3, pp. 379–385, 1981.
[85]
J. le Mée, F. Paye, A. Sauvanet et al., “Incidence and reversibility of organ failure in the course of sterile or infected necrotizing pancreatitis,” Archives of Surgery, vol. 136, no. 12, pp. 1386–1390, 2001.
[86]
R. Flint and J. A. Windsor, “Early physiological response to intensive care as a clinically relevant approach to predicting the outcome in severe acute pancreatitis,” Archives of Surgery, vol. 139, no. 4, pp. 438–443, 2004.
[87]
B. Rau, W. Uhl, M. W. Büchler, and H. G. Beger, “Surgical treatment of infected necrosis,” World Journal of Surgery, vol. 21, pp. 155–161, 1997.
[88]
H. G. Beger, B. Rau, and R. Isenmann, “Natural history of necrotizing pancreatitis,” Pancreatology, vol. 3, no. 2, pp. 93–101, 2003.
[89]
T. Schr？der, V. Sainio, L. Kivisaari, P. Puolakkainen, E. Kivilaakso, and M. Lempinen, “Pancreatic resection versus peritoneal lavage in acute necrotizing pancreatitis: a prospective randomized trial,” Annals of Surgery, vol. 214, no. 6, pp. 663–666, 1991.
[90]
B. M. Rau and H. G. Beger, “. Necrosectomy and closed lavage,” in Diseases of the Pancreas Current Surgical Therapy, H. G. Beger, S. Matsuno, J. L. Cameron, B. M. Rau, M. Sunamura, and R. D. Schulick, Eds., pp. 231–240, Springer, Berlin, Germany, 2008.
[91]
E. L. Bradley, “Management of infected pancreatitis necrosis by open drainage,” Annals of Surgery, vol. 206, no. 4, pp. 542–550, 1987.
[92]
J. Werner, W. Hartwig, and M. W. Büchler, “Management of acute pancreatitis and complications,” in Surgery of the Liver, Biliary Tract, and Pancreas, L. H. Blumgart, Ed., pp. 700–712, Elsevier, Philadelphia, Pa, USA, 4th edition, 2006.
[93]
E. L. Bradley, “Operative management of acute pancreatitis: ventral open packing,” Hepato-Gastroenterology, vol. 38, no. 2, pp. 134–138, 1991.
[94]
G. Tsiotos and M. G. Sarr, “Planned repeated necrosectomy,” in Atlas of Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery, P.-A. Clavien, M. G. Sarr, Y. Fong, and P. Georgiev, Eds., pp. 904–909, Springer, Berlin, Germany, 2007.
[95]
W. Uhl, O. Strobel, and M. W. Büchler, “Open necrosectomy with closed postoperative lavage,” in Atlas of Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery, P.-A. Clavien, M. G. Sarr, Y. Fong, and P. Georgiev, Eds., pp. 895–900, Springer, Berlin, Germany, 2007.
[96]
C. Fernandez-del Castillo, “Necrosectomy and closed packing,” in Atlas of Upper Gastrointestinal and Hepato-Pancreato-Biliary Surgery, P.-A. Clavien, M. G. Sarr, Y. Fong, and P. Georgiev, Eds., pp. 901–903, Springer, Berlin, Germany, 2007.
[97]
M. Büchler, A. Hauka, and P. Malfertheiner, “Follow-up after acute pancreatitis: morphology and function,” in Acute Pancreatitis: Research and Clinical Management, H. G. Beger and M. Büchler, Eds., pp. 367–374, Springer, Berlin, Germany, 1987.
[98]
C. R. Carter, C. J. McKay, and C. W. Imrie, “Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pancreatic necrosis: an initial experience,” Annals of Surgery, vol. 232, no. 2, pp. 175–180, 2000.
[99]
S. Connor, P. Ghaneh, M. Raraty et al., “Minimally invasive retroperitoneal pancreatic necrosectomy,” Digestive Surgery, vol. 20, no. 4, pp. 270–277, 2003.
[100]
K. D. Horvath, L. S. Kao, A. Ali, K. L. Wherry, C. A. Pellegrini, and M. N. Sinanan, “Laparoscopic assisted percutaneous drainage of infected pancreatic necrosis,” Surgical Endoscopy, vol. 15, no. 7, pp. 677–682, 2001.
[101]
G. Castellanos, A. Pi？ero, A. Serrano, and P. Parrilla, “Infected pancreatic necrosis: translumbar approach and management with retroperitoneoscopy,” Archives of Surgery, vol. 137, no. 9, pp. 1060–1063, 2002.
[102]
M. G. T. Raraty, C. M. Halloran, S. Dodd et al., “Minimal access retroperitoneal pancreatic necrosectomy: improvement in morbidity and mortality with a less invasive approach,” Annals of Surgery, vol. 251, no. 5, pp. 787–793, 2010.
[103]
A. L. Warshaw, “Improving the treatment of necrotizing pancreatitis—a step up,” The New England Journal of Medicine, vol. 362, no. 16, pp. 1535–1537, 2010.
