Pancreatic Debridement
- The step-up approach entails starting with the most minimally invasive intervention and escalating as necessary.
- Endoscopic debridement:
- This method is used for collections in close proximity to the stomach or duodenum, and the necrosis must be walled off or mature. It must be performed by an advanced gastroenterologist.
- Minimally invasive video-assisted retroperitoneal debridement (VARD):
- Perform percutaneous drainage first to temporize the patient and allow for a tract to form. Use the drain to guide access to the cavity for debridement.
- Open necrosectomy:
- The goal of this method is complete drainage and removal of all necrotic tissue. It is best for patients with large, difficult-to-access (paracolic gutters, mesocolon), or multiple areas of necrosis, as well as for those patients needing simultaneous interventions (cholecystectomy, feeding tube).