Minimally invasive surgical necrosectomy for infected walled-off necrosis using endoscopy with the flexible overtube technique : A case report

Background: Minimally invasive surgery with a step-up approach is essential for treating infected walled - off necrosis (WON) which has a high mortality rate. Percutaneous endoscopic necrosectomy with a flexible overtube which has various advantages is performed in our institution. We herein introduce safety and easy percutaneous endoscopy with flexible overtube technique for minimally invasive surgical necrosectomy. Case presentation: The patient was placed in the supine position and tilted to the right lateral side. The skin was incised 8cm according to the situated percutaneous drains. Following the tract of the drain, the cavity of infected WON was reached in the retroperitoneum. The percutaneous drain was removed, and a flexible overtube was inserted. An endoscope was inserted through the flexible overtube. The necrosis was then crushed with saline flushing and removed by suction or forceps. A new drain was placed in the cavity to allow continuous drainage after surgery. Necrosectomy should be limited to a glimpse of normal granulation tissue, as aggressive debridement carries a risk of bleeding and/or organ injury. Using the step-up approach, endoscopy may be useful in cases of minimal residual necrosis. Conclusion: Percutaneous endoscopy with the flexible overtube technique for minimally invasive surgical necrosectomy is easy to perform and safe for treating infected WON.
Acta medica Nagasakiensia, 66(2), pp.93-97; 2023