Minimally Invasive Retroperitoneal Pancreatic Necrosectomy (MIRPS)

Created Oct 2014
Reviewed Dec 2019

Query

Minimally invasive retroperitoneal pancreatic necrosectomy is performed for necrotising pancreatitis.

A skunk wire is firstly inserted into the necrosis in Interventional Radiology and then the patient is transferred to theatre for the necrosectomy.  The procedure is usually repeated a few times during the admission (see procedure details below).

PLACEMENT OF SKUNK WIRE
CLINICAL DETAILS:
Pancreatitis. For Skunk procedure
PROCEDURE and FINDINGS:
Under ultrasound guidance, puncture was made into the tail the pancreas, immediately inferior to the tip of the spleen, via a left lower intercostal space, one space lower and further posteriorly to the existing drainage catheter. Pus was aspirated.
A guidewire was inserted, and then manipulated along the pancreatic bed to the region of the pancreatic head.
The patient remained stable throughout.  No immediate complication.
He was then transferred directly to the operating theatre
COMMENT:
Successful insertion of Skunk wire

The ACHI code we assigned is 30577-00 [979] Major pancreatic or retroperitoneal dissection.  Does NZCA agree?

Response

Yes.  Minimally invasive necrosectomy involves the removal of dead pancreatic tissue using keyhole surgery. 

30577-00 [979] Major pancreatic or retroperitoneal dissection should be assigned by following the below ACHI Index.  This code will be used for open procedures, therefore. free text should be used to specify the procedure performed.

Dissection

- pancreas (major) (retropancreas)
- - for
- - - pancreatic necrosis 30577-00 [979]

If there is documentation of the use of either a laparoscopic or endoscopic approach, then refer to ACS 0023 Laparoscopic/Arthroscopic/Endoscopic Surgery

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