Pancreatic necrosectomy

1.Position the patient supine.
2.Upper midline incision (or rooftop).
3.Conduct a laparotomy. If the GB is still present, perform a cholecystectomy and cholangiogram.
4.You may need to mobilize both colonic flexures. Enter the lesser through the gastrocolic omentum and begin to debride necrotic pancreas with blunt finger dissection and a Yankauer sucker.
5.Insert a feeding jejunostomy.
6.Further options include
•Multiple closed drains. This may require further second look laparotomy.
•Open packing and laparostomy with multiple planned re-look laparotomy until granulation tissue forms. This is only done if there is extensive bleeding.
•Closed lavage using multiple large bore suction drains and continuous lavage using CAPD dialysis fluid at 500ml/hr (Beger).
•Others – Fagniez flank approach, minimally invasive approaches.