14. Necrosectomy blog
  • Pancreatic Necrosectomy is the surgical removal of dead tissue from the patient with pancreatic swelling (called necrotizing pancreatitis). A surgeon may recommend this procedure when the dead tissue has taken up infection.

  • The surgeon typically operates on a patient under general anesthesia to make sure the patient remains comfortable throughout the surgery.

The pancreatic necrosectomy can last from 2 hours to 6 hours, depending upon the complexity of the problem.

Usually there are three variations of pancreatic necrosectomy.
  • Endoscopic procedure
  • VARD (Video assisted)
  • Open surgery

Endoscopic pancreatic necrosectomy is performed during an upper endoscopy . You will lie on your left side for the procedure and receive pain-relieving medication and sedation through an IV line to relax you and make you feel drowsy.

A mouth guard will be placed to protect your teeth and gums. Your throat may also be numbed with a spray to calm the gag reflex. The doctor will insert the endoscope through the mouth, passing it down through the esophagus into the stomach or duodenum (the first part of the small intestine).

Using a combination of endoscopic ultrasound (EUS) and live X-ray images, the doctor inserts a stent from the stomach to the pancreas, which allows any accumulation of pancreatic fluid to drain into the stomach. The endoscope is guided through the stent into the pancreas, and, using a variety of tools inserted through the endoscope, the doctor will then remove the dead pancreatic tissue.

This advanced procedure can range from 1-3 hours. It usually takes more than one procedure to remove all the dead pancreatic tissue. Complete endoscopic necrosectomy may be performed in as few as 2 procedures, but it occasionally takes 4 or 5 procedures. These subsequent endoscopies are performed within 1 or 2 weeks of the initial procedure.

VARD procedure stands for Video Assisted Retroperitoneal Necrosectomy. You will be given a general anaesthesia. The doctor will create a small hole over the left side of tummy. A camera is inserted through this hole. The doctor will use various instruments to remove dead tissue with help of camera vision.

You will have a tube coming out of your abdomen after the procedure. The procedure usually takes 1 to 4 hours.

Doctor may make an arrangement by which water is kept flowing inside your tummy via one tube & exits the tummy via another tube. This type of arrangement helps clean up the dead infected area.

You will be under general anaesthesia. The doctor performs the surgery by putting a cut over your tummy. During the procedure the doctor will remove the dead & infected area around & within pancreas. Once the procedure is complete the doctor will place multiple tubes coming out from the tummy & stitch the abdominal wall together.

Your doctor will warn you regarding following complications
  • Bleeding
  • Fever
  • Pain
  • Infection
Dr. Harsh J Shah