title: Roux-en-Y internal drainage is the best surgical option to treat patients with disconnected duct syndrome after severe acute pancreatitis.
abstract: BACKGROUND
  Roux-en-Y (RNY) internal drainage has been our primary surgical strategy to definitively treat disconnected duct syndrome in patients after severe acute pancreatitis (SAP). This study compares the results of internal drainage with the results of distal pancreatectomy-splenectomy (DPS) performed in a contemporaneous group of patients.
  
  
  METHODS
  For 5 years (June 1995 to June 2000), 27 consecutive patients with disconnected duct syndrome after SAP were identified: 13 treated with internal drainage and 14 with DPS. Fistula characteristics, operative management, and clinical outcome were analyzed. Comparisons between groups were made with the Student t test and Fisher exact test, with statistical significance defined as P <.05.
  
  
  RESULTS
  Age, sex, etiology of pancreatitis, comorbid diseases, and prior operations were similar between groups. Internal drainage required less operative time (211 +/- 37 vs 269 +/- 88 minutes, P =.04), blood loss (735 +/- 706 vs 2757 +/- 3062 mL, P =.03), and transfusion requirements (0.69 +/- 1.7 vs 4.21 +/- 8.0 units, P =.05). Clinical outcomes--as measured by postoperative complication rate, reoperation rate, fistula recurrence rate, and death rate--were similar between groups.
  
  
  CONCLUSIONS
  RNY internal drainage, when technically feasible, is the best surgical option to treat disconnected duct syndrome after SAP.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Howard
authors.forename: G J
authors.initials: GJ
authors.lastname: Rhodes
authors.forename: D J
authors.initials: DJ
authors.lastname: Selzer
authors.forename: S
authors.initials: S
authors.lastname: Sherman
authors.forename: E
authors.initials: E
authors.lastname: Fogel
authors.forename: G A
authors.initials: GA
authors.lastname: Lehman
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010183:Pancreatic Ducts / Q000601:surgery*; D010195:Pancreatitis / Q000150:complications / Q000601:surgery*; D013156:Splenectomy