A necrosectomy is a surgical procedure to remove dead or infected tissue (necrosis). It is performed in severe medical cases, often associated with serious complications of pancreatitis. The goal is to eliminate compromised tissue to prevent health deterioration.
Why Necrosectomy is Necessary
Necrosectomy addresses severe acute pancreatitis, where intense inflammation leads to tissue death. This process, called necrotizing pancreatitis, causes parts of the pancreas and surrounding tissues to die. Dead tissue, especially if infected, can trigger a systemic inflammatory response, potentially leading to widespread infection (sepsis) and organ failure.
Digestive enzymes, normally confined within the pancreas, can leak out during severe inflammation, further damaging tissues and contributing to necrosis. If bacteria enter this dead tissue, often through the bloodstream, they can multiply rapidly, increasing the risk of severe complications. While mild pancreatitis often responds to conservative management, severe cases with necrosis frequently require intensive care and surgical removal to prevent these outcomes.
How Necrosectomy is Performed
Necrosectomy procedures involve different approaches, from traditional open surgery to less invasive techniques, depending on the extent and location of the necrotic tissue. Before the procedure, patients typically fast for about six hours, and imaging like CT scans may guide drain placement. The objective is to remove all necrotic areas while preserving healthy pancreatic tissue.
Traditional open necrosectomy involves a larger abdominal incision, often subcostal or midline, to directly access and remove the dead tissue. This method allows for immediate identification and removal of complications. After tissue removal, the area is often irrigated with saline, and drains are inserted to manage fluids and secretions, including pancreatic juices.
Minimally invasive techniques have gained popularity due to their potential to reduce complications and improve recovery. These include laparoscopic necrosectomy, where small incisions are made and a camera with specialized instruments are used to remove necrotic tissue and debris. Video-assisted retroperitoneal debridement (VARD) is another minimally invasive approach, often used for necrosis primarily on the left side of the abdomen.
Endoscopic necrosectomy is a less invasive option. An endoscope, a thin tube with a camera, is inserted through the mouth, guided into the stomach or duodenum. Instruments then create an opening into the necrotic cavity to remove the dead tissue. This procedure may require multiple sessions, typically 2 to 5, spaced one to two weeks apart, to ensure all material is removed.
Life After Necrosectomy
Following a necrosectomy, patients typically face a recovery period that often involves a hospital stay of 7 to 14 days, though this varies based on individual progress and the approach used. During this initial period, close monitoring manages pain and identifies immediate complications. Pain management is a key aspect of post-operative care, often requiring medication.
Drains are commonly placed during the procedure to help remove any remaining fluid or pancreatic secretions, which may require long-term management or exchanges. Nutritional support is also a key component of recovery, with feeding tubes, such as jejunal tubes, often inserted to ensure adequate nourishment as the body heals. Follow-up appointments are routinely scheduled, initially around two weeks post-operation, then monthly, until a full recovery is achieved. Complete recovery can take several months, as the body needs time to heal and adjust.