The limits of laparoscopic treatment in severe acute pancreatitis

Severe acute pancreatitis is a pathology difficult to treat with a high mortality rate. The feasibility of laparoscopic approach in the treatment of severe pancreatitis is still under discussion. Retrospective study that included a total of 132 patients diagnosed with severe acute pancreatitis admitted in General Surgery Clinic of the Bucharest Emergency Clinical Hospital between January 2016 and December 2018, of which 11 patients (8.3%) received laparoscopic surgical treatment for the reported pathology. From a total of 132 pacients, 107 patients (81%) received conservative treatment for the severe pancreatitis, 14 patients (10.6%) benefited of classical necrectomy, 11 patients (8.3%) benefited of laparoscopic necrectomy followed by external drainage for massive liquid collections and / or infected necrosis in the acute phase of severe pancreatitis, and conversion to open surgery was performed in 4 cases (4/11). For 8 patients (6.1%) who had pancreatic pseudocyst or abscess, intracavitary laparoscopic debridement and external drainage was performed without any complications. The most common cause of severe acute pancreatitis was ethanol consumption. Of the 11 patients with laparoscopic necrectomy, 5 patients experienced postoperative complications: Clostridium difficile colitis, drainage tube haemorrhage, left basal pleural effusion, multiple organ dysfunction. As a conclusion, laparoscopic approach offers an alternative in the treatment of severe acute pancreatitis in selected cases.