Led by Prof. Jiahong Dong of Tsinghua University affiliated Beijing Tsinghua Changgung Hospital and Prof. Shouwang Cai from Department of Hepatobiliary and Pancreatic Surgery of the People's Liberation Army General Hospital, an improved percutaneous nephroscopic approach for clearing peri-pancreas necrotic tissues was developed which significantly increased the efficiency of debriding necrotizing pancreatitis and reduced disease-related mortality. The result of this clinical study was recently published in British Journal of Surgery .

　　https://bjssjournals.onlinelibrary.wiley.com/doi/10.1002/bjs.11619

　　Acute pancreatitis is a common disease and can be classified into interstitial edematous pancreatitis and necrotizing pancreatitis according to pathologic findings. Necrosis and locoregional infection of the pancreas and peri-pancreas tissues cause sepsis, intraabdominal hemorrhage, gastrointestinal perforation, bowel obstruction, etc., which are the main reasons of late phase mortality of patients suffered acute pancreatitis. And the mortality rate can reach as high as 30%. The traditional way of treating necrotizing pancreatitis is debriding necrotic and infected tissues by large-incision laparotomy, continuing flushing and multiple drainage after the operation. Patients always suffer from carrying many draining tubes and endless drainage. However, the mortality and morbidity rates of this disease after treatment stay unsatisfactory yet.

　　In recent years, two minimally invasive approaches have been developed to be the milestones in the surgical treatment to acute pancreatitis, i.e., video-assisted debridement through small incision and percutaneous water-immersed nephroscopic debridement. Despite of these two approaches owning their advantages and drawbacks, the joint research group led by Prof. Jiahong Dong develops a brand new technique based on the two older ones. By opening the treatment tunnel via percutaneous drainage, the gas-immersed nephroscopic approach is well-established and debriding through nephroscope is performed easily afterwards. "Compared to traditional nephroscopic approaches, this technique not only improves the viewing definition, but also allows for multi-tunnel operations, which significantly improving the efficiency and safety of debridement." Says Dr. Shizhong Yang, co-first author of the article. The team also categorizes the various debriding tunnels and establishes a comprehensive decision system for the treatment of residual infection foci conforming to the principle of precision surgery, including the combination of hard and soft nephroscopes, open debridement using small incision, and DSA-guided fistula drainage, etc.

(Left) Wide ranging retroperitoneal necrosis and infection                (Right) Necrotic tissue removed through nephroscopy

　　The peri-pancreas necrotic tissue debridement technique established in this study is of great significance for the treatment of necrotizing pancreatitis with locoregional infection. This technique enriches the therapeutic alternatives for necrotizing pancreatitis, validates the effectiveness of step-up treatment, and provides valuable reference in the treatment of intractable wide-range retroperitoneal necrosis and infection. In comparison with similar studies in the world, this study included more complex cases with a higher rate of 54.9% but resulted in a lower mortality rate (6.1%). "The new technique established in this study conforms to the concept of precision surgery, which is safe, minimally invasive and highly efficient. This technique deserves wide promotion to benefit more patients suffering from severe pancreatitis." Says Prof. Jiahong Dong, leader of this team, academician of Chinese Academy of Engineering.(Reviewer Jiang Liu)