{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T07:31:37Z","timestamp":1784014297421,"version":"3.55.0"},"reference-count":16,"publisher":"FapUNIFESP (SciELO)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ABCD, arq. bras. cir. dig."],"abstract":"<jats:p>ABSTRACT   Background : Acute pancreatitis is the third most common gastrointestinal disorder requiring hospitalization in the United States, with annual costs exceeding $2 billions. Severe necrotizing pancreatitis is a life-threatening complication developed in approximately 20% of patients. Its mortality rate range from 15% in patients with sterile necrosis to up 30% in case of infected one associated with multi-organ failure. Less invasive treatment techniques are increasingly being used. These techniques can be performed in a so-called step-up approach.  Aim: To present the technique for videoscopic assisted retroperitoneal debridement (Vard technique) with covered metallic stent in necrotizing pancreatitis.  Method: A guide wire was inserted through the previous catheter that was removed in the next step. Afterwards, the tract was dilated over the guide wire. Then, a partially covered metallic stent was deployed. A 30 degrees laparoscopic camera was inserted and the necrosis removed with forceps through the expanded stent under direct vision. Finally, the stent was removed and a new catheter left in place.   Result : This technique was used in a 31-year-old man with acute pain in the upper abdomen and diagnosed as acute biliary pancreatitis with infected necrosis. He was treated with percutaneous drains at weeks 3, 6 and 8. Due to partial recovery, a left lateral VARD was performed (incomplete by fixed and adherent tissue) at 8th week. As the patient\u00b4s inflammatory response was reactivated, a second VARD attempt was performed in three weeks later. Afterwards, patient showed complete clinical and imaging resolution.   Conclusions :  Videoassisted retroperitoneal necrosectomy using partially covered metallic stent is a feasible technique for necrotizing pancreatitis.<\/jats:p>","DOI":"10.1590\/0102-672020180001e1379","type":"journal-article","created":{"date-parts":[[2018,7,7]],"date-time":"2018-07-07T20:43:43Z","timestamp":1530996223000},"source":"Crossref","is-referenced-by-count":4,"title":["NECROTIZING PANCREATITIS: DESCRIPTION OF VIDEOSCOPIC ASSISTED RETROPERITONEAL DEBRIDEMENT (VARD) TECHNIQUE WITH COVERED METALLIC STENT"],"prefix":"10.1590","volume":"31","author":[{"given":"Eduardo J.","family":"HOUGHTON","sequence":"first","affiliation":[{"name":"Hospital Bernardino Rivadavia,  Argentina; University of Buenos Aires,  Argentina; DAICIM Foundation,  Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alain A. Garc\u00eda","family":"V\u00c1ZQUEZ","sequence":"additional","affiliation":[{"name":"DAICIM Foundation,  Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel E.","family":"ZELED\u00d3N","sequence":"additional","affiliation":[{"name":"University of Costa Rica,  Costa Rica"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"ANDREACCHIO","sequence":"additional","affiliation":[{"name":"Hospital Pi\u00f1ero,  Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"RUIZ","sequence":"additional","affiliation":[{"name":"Hospital Bernardino Rivadavia,  Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariano","family":"PALERMO","sequence":"additional","affiliation":[{"name":"Hospital Bernardino Rivadavia,  Argentina; DAICIM Foundation,  Argentina; Hospital Nacional Prof. Alejandro Posadas,  Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariano E.","family":"GIMENEZ","sequence":"additional","affiliation":[{"name":"University of Buenos Aires,  Argentina; DAICIM Foundation,  Argentina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2018,7,2]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"2379","DOI":"10.1111\/j.1572-0241.2006.00856.x","article-title":"Practice guidelines in acute pancreatitis","volume":"101","author":"Banks PA","year":"2006","journal-title":"Am J Gastroenterol"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"175 80","DOI":"10.1097\/00000658-200008000-00004","article-title":"Percutaneous necrosectomy and sinus tract endoscopy in the management of infected pancreatic necrosis: an initial experience","volume":"232","author":"Carter CR","year":"2000","journal-title":"Ann Surg"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1159\/000071184","article-title":"Minimally invasive retroperitoneal pancreatic necrosectomy","volume":"20","author":"Connor S","year":"2003","journal-title":"Dig Surg"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1002\/bjs.1800760316","article-title":"Direct retroperitoneal approach to necrosis in severe acute pancreatitis","volume":"76","author":"Fagniez PL","year":"1989","journal-title":"Br J Surg"},{"issue":"Suppl 1","key":"ref5","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s12262-014-1197-0","article-title":"Management of Infected Pancreatic Necrosis-The \"Step Up\" Approach and Minimal Access Retroperitoneal Pancreatic Necrosectomy","volume":"77","author":"John BJ","year":"2015","journal-title":"The Indian Journal of Surgery"},{"issue":"37","key":"ref6","doi-asserted-by":"crossref","first-page":"13412","DOI":"10.3748\/wjg.v20.i37.13412","article-title":"Surgical and interventional management of complications caused by acute pancreatitis","volume":"20","author":"Karakayali FY","year":"2014","journal-title":"World Journal of Gastroenterology: WJG"},{"issue":"43","key":"ref7","doi-asserted-by":"crossref","first-page":"16106","DOI":"10.3748\/wjg.v20.i43.16106","article-title":"Surgical management of necrotizing pancreatitis An overview","volume":"20","author":"Kokosis G","year":"2014","journal-title":"World Journal of Gastroenterology: WJG"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"693040","DOI":"10.1155\/2015\/693040","article-title":"Minimally invasive necrosectomy techniques in severe acute pancreatitis role of percutaneous necrosectomy and video-assisted retroperitoneal debridement","volume":"2015","author":"Logue JA","year":"2015","journal-title":"Gastroenterol Res Pract"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1080\/00855920310002799","article-title":"Surgical management of acute necrotizing pancreatitis: a 13-year experience and a systematic review","author":"Nieuwenhuijs VB","year":"2003","journal-title":"Scand J Gastro- enterol"},{"key":"ref10","article-title":"Timing of surgical intervention in patients of infected necrotizing pancreatitis not responding to percutaneous catheter drainage","author":"Shenvi S","year":"2016","journal-title":"Pancreatology"},{"issue":"4","key":"ref11","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1590\/S0102-67202010000400013","article-title":"Quando e como tratar as complica\u00e7\u00f5es na necrose pancre\u00e1tica infectada","volume":"23","author":"Silva Rodrigo Altenfelder","year":"2010","journal-title":"ABCD, arq. bras. cir. dig"},{"issue":"3","key":"ref12","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1590\/0102-6720201600030018","article-title":"Understanding the international consensus for acute pancreatitis: classification of Atlanta 2012","volume":"29","author":"Souza Gleim Dias de","year":"2016","journal-title":"ABCD, arq. bras. cir. dig"},{"key":"ref13","article-title":"A patient with severe acute pancreatitis and necrosis shows systemic inflammatory response syndrome (SIRS) 9 days after the onset of pancreatitis, What should we do","author":"van Dijk SM","year":"2017","journal-title":"Hepato-Pancreato-Biliary and Transplant Surgery: Practical Management of Dilemmas"},{"issue":"7","key":"ref14","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1038\/ajg.2014.130","article-title":"Endoscopic interventions for necrotizing pancreatitis","volume":"109","author":"Trikudanathan G","year":"2014","journal-title":"Am J Gastroenterol"},{"issue":"16","key":"ref15","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1056\/NEJMoa0908821","article-title":"A step-up approach or open necrosectomy for necrotizing pancreatitis ; 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