PANCREAS > Laparoscopic Pancreatic Necrosectomy

Patient and Port position: Patient placed in modified Lloyd Davies position.

Pneumoperitoneum is created by veress needle through 10 mm Supraumbilical skin incision which later on is converted into 10mm camera port. 10mm right & left working ports in mid clavicular line, 5mm port in epigastrium, 5mm port in left anterior axillary line in lumbar region and 5mm port in right iliac fossa.

STEPS:
After initial general assessment of peritoneal cavity lesser sac is opened by dividing gastrocolic ligament. Retrogastric adhesions separated. Cavity localized by aspirating pus from anterior surface of body of pancreas. Transverse incision given at the site of pus aspiration and incision enlarged. Pus and necrotic tissues evacuated from head, body and tail region of pancreas. Thorough wash is given and two drains placed in pancreatic cavity through port sites. These drain tubes may be used for subsequent lavage in the post operative period. Feeding jejunostomy is done by foley’s catheter 20cm distal to duodenojejunal flexure.