# Video assisted retroperitoneal debridement for infected pancreatic necrosis: A two port approach for difficult access

## TL;DR

A two-port video-assisted retroperitoneal debridement approach is presented as an effective minimally invasive treatment for infected pancreatic necrosis.

## Contribution

A two-port approach for video-assisted retroperitoneal debridement is proposed to manage difficult access in infected pancreatic necrosis.

## Key findings

- Video-assisted retroperitoneal debridement using a two-port approach successfully reduced peripancreatic collections in a complex case.
- The procedure demonstrated a safety profile with reduced postoperative complications compared to open surgery.
- Minimally invasive techniques like VARD are increasingly preferred over traditional open surgery for infected pancreatic necrosis.

## Abstract

The incidence of acute pancreatitis varies globally, and its rates are increasing. Timely intervention in cases of infected necrosis is crucial to effective management. The landscape of acute pancreatitis management has undergone transformation through adopting a “step-up” strategy, accentuating the shift towards minimally invasive techniques.

A 63-year-old patient with acute pancreatitis and infected pancreatic necrosis underwent a challenging yet successful treatment using video-assisted retroperitoneal debridement employing a two-port approach facilitated access for an intricate area. The procedure, performed 45 days after admission, effectively reduced peripancreatic collections, demonstrating the efficacy of this approach in managing complex cases of infected pancreatic necrosis.

The management of acute pancreatitis has evolved towards a comprehensive strategy involving early hydration, nutritional support, effective pain management, and interventions. Infected pancreatic necrosis poses a serious complication, with minimally invasive techniques such as video-assisted retroperitoneal debridement (VARD) emerging as preferred options. The efficacy and safety of VARD in complex cases are highlighted, although challenges persist, especially in extensive necrosis.

The VARD procedure, a key component of the step-up approach, exhibits a remarkable safety profile, substantially reducing postoperative complications and mortality compared to open surgical counterparts. However, challenges persist in managing cases of infected Walled-Off Necrosis with deep extension, necessitating carefully considering a minimal-access approach. We report our experience using the VARD in a two-port approach.

•Infected pancreatic necrosis poses high morbidity and mortality risks.•Management evolution: Shift from traditional open surgery to "step-up" strategy using minimally invasive techniques.•A 63-year-old patient with acute pancreatitis underwent video-assisted retroperitoneal debridement.•Timing is key: Delay intervention in sterile necrosis. Inmmediate action needed for infected necrosis to reduce mortality.•Managing infected necrosis is tough, sometimes needing extra open necrosectomy; consider minimal-access approaches.

Infected pancreatic necrosis poses high morbidity and mortality risks.

Management evolution: Shift from traditional open surgery to "step-up" strategy using minimally invasive techniques.

A 63-year-old patient with acute pancreatitis underwent video-assisted retroperitoneal debridement.

Timing is key: Delay intervention in sterile necrosis. Inmmediate action needed for infected necrosis to reduce mortality.

Managing infected necrosis is tough, sometimes needing extra open necrosectomy; consider minimal-access approaches.