Interventional pancreaticojejunostomy after pancreatoduodenectomy.
BACKGROUND
Leakage from the pancreaticoenteric anastomosis after pancreatoduodenectomy (PD) is closely associated with intra-abdominal hemorrhage with ensuing high mortality.


METHODS
Interventional pancreaticojejunostomy was performed in 10 patients with external drainage of pancreatic juice after two-staged PD or leakage from pancreaticojejunostomy after PD. The jejunum was punctured using a 22-gauge needle into the pancreatic fistula during endoscopic observation of the jejunal lumen, followed by the insertion of two 0.35-inch guide-wires into the jejunum and pancreatic fistula. Finally, a stenting tube was placed between the jejunum and pancreatic fistula.


RESULTS
No severe complications developed. Oral intake was instituted the following day in 8 of 10 patients, and on the 7th day in the remaining two patients.


CONCLUSIONS
This interventional procedure is considered to be safe and easy to perform, and in the future, it may permit a reduction in the number of second laparotomies in pancreatic fistula.
Cho
Akihiro
A
Gastroenterological Surgery, Chiba Cancer Center Hospital, Chiba, Japan. acho@chiba-cc.jp
D000368:Aged; D000369:Aged, 80 and over; D004067:Digestive System Neoplasms / Q000601:surgery; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy; D012086:Reoperation; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000601:surgery*