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WJOLS


                                                   Role of Minimal Access Surgery in Management of Infective Pancreatic Necrosis

          approaches that have risen to favor are the endoscopic  ACKNOWLEDGMENT
          transgastric and nephroscopic retroperitoneal routes, probably  The guidance provided by Professor Dr RK Mishra, Director,
          because they are based on conventional operations.  Laparoscopy Hospital, Tilak Nagar, Delhi, is sincerely
             The former is an adaptation of an open surgical approach,  appreciated and acknowledged.
          developed to treat retrogastric pseudocysts, that has been
          extended to include endoluminal ultrasonographically-guided  REFERENCES
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          necrosum and transpapillary stenting of the pancreatic duct.  2. Rau B, Steinbach G, Gansauge F, et al. The potential role of
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          transgastric operation.                              3. Traverso LW, Kozarek RA. Pancreatic necrosectomy: Definitions
                                                                  and technique. J Gastrointest Surg 2005;9:436-39.
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          the stomach or duodenal wall. The nephroscopic retroperitoneal  5. Götzinger P, Wamser P, Barlan M, et al. Candida infection of
                                                                  local necrosis in severe acute pancreatitis is associated with
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          appears now to be the most popular MAN approach. It is an   6. Freeny PC, Hauptmann E, Althaus SJ, Traverso LW, Sinanan
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             MAN has now passsed the stage of feasibility testing and  7. Bradley EL, Allen K. A prospective longitudinal study of
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             Now, with the advent of robotic surgery even within few  1989;76:264-67.
          years it will be possible to perform the IPN surgery with maximum  12. Villazón A, Villazón O, Terrazas F, Raña R. Retroperitoneal
          accuracy. However, a prospective double-blind study is  drainage in the management of the septic phase of severe acute
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          required for the same over a span of at least 5 years with  13. Castellanos G, Piñero A, Serrano A, et al. Translumbar
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                                                                  management of drained infected pancreatic necrosis. Arch Surg
          CONCLUSION                                              2005;140:952-55.
                                                              14. Wilson PG, Manji M, Neoptolemos JP. Acute pancreatitis as a
          Pancreatic necrosectomy by minimal access surgery is    model of sepsis. J Antimicrob Chemother 1998;41:51-63.
          feasible and on the available evidence there is no doubt that  15. Carter CR, McKay CJ, Imrie CW. Percutaneous necrosectomy
          it has a major role to play in reducing both systemic insult  and sinus tract endoscopy in the management of infected
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          surgery and with the development of better instruments and  18. Binmoeller KF (May 19, 2008). Pancreas-endoscopic
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          World Journal of Laparoscopic Surgery, September-December 2011;4(3):160-165                       165
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