Minimally Invasive Approaches to Infected Pancreatic Collections:  Comment on “Safety and Efficacy of Video-Assisted Retroperitoneal Debridement for Infected Pancreatic Collections”

In this article, Dr Horvath and her colleagues from 3 separate facilities describe their experience with VARD for infected pancreatic “collections.” Congratulations to this group for completing a prospective evaluation of a novel surgical approach. Minimally invasive approaches for pancreatic debridement have been reported by several groups and include percutaneous, laparoscopic, retroperitoneal, and transgastric methods. Our group at the University of California, Los Angeles School of Medicine has had some success with laparoscopic debridement. The efficacy for most of these methods has yet to be universally accepted, but in the future pancreatic surgeons will need expertise with a combination of these techniques so that we can effectively treat all patients without open surgery. This article has shown that in a highly select group of patients VARD is feasible, safe, and effective, and perhaps less morbid than open surgery. In addition, the data suggest that percutaneous drainage alone may be all that is needed for some patients.