Retroperitoneoscopic drainage of a retroperitoneal abscess when open surgery is not an option: a novel surgical technique

Abstract

Objective: An open cholecystectomy has specific surgical indications, including cirrhosis, vesicular cancer, and severe adherence syndrome. Abscesses resulting from the open surgery corresponds to 1% of complications. When located in the retroperitoneum, these abscesses are life-threatening conditions, having a high mortality from a delayed diagnosis or incomplete drainage. Treatment can be conservative, surgical or endoscopically. Materials and Methods: In the right lateral decubitus position, between the medial and posterior axillary lines, inferior to the twelfth costal space an incision is made for the 12mm trocar. Avulsion and resection of the lateral abdominal muscles and latissimus dorsi muscle until inside the retroperitoneum, where under direct vision, the 5mm and the pneumatic trocar are inserted above and anterior to the iliac crest. Results: Through the retroperitoneum scope, the retroperitoneum space is easily accessed to ensure complete abscess drainage. In the out-patient consults, there were no resulting complications reported. Discussion: Retroperitoneal infections are a surgical and diagnostic challenge. The abscess classification depends on the anatomic location which can direct any of the therapeutic options, between the conservative, surgical, or percutaneous drainage. The conservative approach is reserved for small collections (<3cm), the percutaneous is widely used but not exempt from complications, and more recently the minimally invasive approach, the retroperitoneoscopic drainage, has shown superior benefits, with complete drainage and debridement leading to a decreased recurrence rate. Conclusions: We propose a retroperitoneum scope access as a safe and ideal method to drain retroperitoneal abscesses in patients whom a conservative approach cannot be performed, or those who cannot undergo a percutaneous or open surgical technique.