Resumo

CARRILLO, Luis Miguel et al. Laparoendoscopic cystogastric bypass of a pancreatic necrosis. Case report. Cir. gen [online]. 2022, vol.44, n.3, pp.131-135.  Epub 20-Out-2023. ISSN 1405-0099.  https://doi.org/10.35366/109773.

The incidence of acute pancreatitis (AP) is increasing, up to 0.7 hospitalizations per 1,000 inhabitants in the U.S. In 80% of patients, AP is mild and self-limited, but up to 20% of patients may have a severe necrotizing course, responsible for substantial morbidity and a mortality rate of up to 27%. The main cause of death is necrosis infection, which is associated with a poor prognosis with a mortality of 15 to 39%. Until very recently, the gold standard for treating infected necrosis used to be surgical necrosectomy by laparotomy. This procedure provides wide access to infected necrosis but is highly invasive and is associated with morbidity rates of 34 to 95% and mortality rates of 11 to 39%. Alternative methods primarily involve debridement using retroperitoneal, laparoscopic, endoscopic, or combinations of these. They share the common goal of avoiding laparotomy and together are known as “minimally invasive necrosectomy”. These techniques continue to evolve and undergo refinement. To date there is no evidence or randomized trials comparing these techniques with traditional “open” necrosectomy or, equally important, comparing different minimally invasive necrosectomy techniques with each other. This presents a problem for surgeons dealing with patients with pancreatic necrosis as they need to consult the available evidence to guide the selection of their treatment. This case provides a concise but general description of a minimally invasive approach with special reference to technique and outcome.

Palavras-chave : pancreatitis; cystogastric bypass; minimally invasive.