title: Two-staged hepato-pancreatoduodenectomy and interventional pancreaticojejunostomy.
abstract: Two-staged pancreatoduodenectomy, including exteriorization of the pancreatic juice and second-look pancreaticojejunostomy, has been recommended for high-risk patients to avoid pancreatic leakage, which often causes intra-abdominal hemorrhage. We present a new technique of interventional pancreaticojejunostomy under both fluoroscopy and endoscopy without second-look laparotomy. A 77-year-old woman with local recurrence and liver metastasis from colon cancer underwent hepato-pancreatoduodenectomy with the external drainage of pancreatic juice via the pancreatic duct tube without pancreaticojejunostomy. Two months later, the jejunum was punctured with the insertion of a 5-F needle-knife into the pancreatic fistula during endoscopic observation of jejunal lumen, followed by the insertion of two 0.35-inch guidewires into the jejunum and the pancreatic fistula. Finally, a 10-Fr stenting tube was placed between the jejunum and the pancreatic fistula. No complications developed.
authors.affiliation: Department of Surgery, Seirei Sakura Citizen Hospital, Japan. acho@chiba-cc.jp
authors.forename: Akihiro
authors.initials: A
authors.lastname: Cho
authors.forename: Seiji
authors.initials: S
authors.lastname: Arita
authors.forename: Naoto
authors.initials: N
authors.lastname: Koike
authors.forename: Naohide
authors.initials: N
authors.lastname: Isaka
authors.forename: Kenichi
authors.initials: K
authors.lastname: Kusume
authors.forename: Shinichi
authors.initials: S
authors.lastname: Okazumi
authors.forename: Harufumi
authors.initials: H
authors.lastname: Makino
authors.forename: Takayuki
authors.initials: T
authors.lastname: Tohma
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Matsubara
authors.forename: Hisashi
authors.initials: H
authors.lastname: Gunji
authors.forename: Takenori
authors.initials: T
authors.lastname: Ochiai
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology* / Q000601:surgery; D003131:Combined Modality Therapy; D016145:Endoscopy, Digestive System / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000473:pathology / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology / Q000628:therapy; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000009:adverse effects / Q000379:methods*; D018570:Risk Assessment; D015607:Stents; D016896:Treatment Outcome