Percutaneous retroperitoneal endoscopic necrosectomy

NICE interventional procedure guidance [IPG384] Published date:

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The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Percutaneous retroperitoneal endoscopic necrosectomy.

It replaces the previous guidance on Percutaneous pancreatic necrosectomy, (Interventional Procedures Guidance no.33, December 2003).  

  • Description

    The pancreas produces juices that contain substances (enzymes) that help to digest food. Sometimes these substances can attack the pancreas itself. This can happen if the tube that normally takes the juices to the gut becomes blocked. This can cause swelling of the pancreas and severe pain in the abdomen (acute pancreatitis). Some patients with acute pancreatitis develop a complication called necrosis, when part of the pancreas is destroyed.  This is a serious condition with high risk of death, and removal of the dead tissue is required as part of the management.

    The usual way of removing the destroyed part of the pancreas is by open surgery. Percutaneous retroperitoneal endoscopic necrosectomy is an alternative treatment option where a thin telescope, inserted through a small cut in the side above the hip, is used to wash out and remove the dead tissue.

  • OPCS4.6 Code(s)

    J57.6 Pancreatic necrosectomy

    Y75.2 Laparoscopic approach to abdominal cavity NEC

    Note: Drainage performed in addition would be coded to J66.1Percutaneous drainage of lesion of pancreas and insertion of cystogastrostomy tube NEC,  or J66.2 1Percutaneous drainage of lesion of pancreas and insertion of temporary external drain HFQ, or J66.3 Percutaneous drainage of lesion of pancreas NEC (Includes needle aspiration of pancreas NEC).

    The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.

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