title: A minimally invasive approach for postoperative pancreatic fistula.
abstract: Pancreas fistula is a well-known and severe complication of pancreaticoduodenectomy. It is difficult to control with conservative therapy, inducing further complications and severe morbidity. Until now, re-operation has been the only way to resolve pancreatic fistula causing complete dehiscence of the pancreatic-enteric anastomosis (complete pancreatic fistula). Percutaneous transgastric fistula drainage is one of the treatments for pancreatic fistula. This procedure allows both pancreas juice drainage and anastomosis re-construction at the same time. This is effective and minimally invasive but difficult to adapt to a long or complicated fistula. In particular, dilatation of the main pancreatic duct is indispensable. This paper reports the successful resolution of a postoperative pancreatic fistula by a two-way-approach percutaneous transgastric fistula drainage procedure. Using a snare catheter from the fistula and a flexible guidewire from the transgastric puncture needle, it can be performed either with or without main pancreatic duct dilatation.
authors.affiliation: Third Department of Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi kamimachi, Itabashi-ku, Tokyo 173-8610, Japan. yamazaki-nmed@umin.ac.jp
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yamazaki
authors.forename: Kenmei
authors.initials: K
authors.lastname: Kuramoto
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Itoh
authors.forename: Yoshika
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Toshisada
authors.initials: T
authors.lastname: Ueda
mesh_terms: D000368:Aged; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010185:Pancreatic Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects; D015641:Radiography, Interventional / Q000379:methods; D016896:Treatment Outcome