title: Fistulojejunostomy for the management of refractory pancreatic fistula.
abstract: BACKGROUND
  Pancreatic fistula (PF) formation is a known complication of pancreatic surgery, pancreatitis, and pancreatic injury. When medical or endoscopic interventions fail to resolve PF, operation remains the only viable treatment option. Unfortunately, operation for the correction of PF is often difficult and associated with significant morbidity.
  
  
  METHODS
  Herein, we report on our experience with a previously described technique for the management of PF that is performed easily and is associated with reduced morbidity. During the period of 2003-2006, 8 patients (males = 6, female = 2) with PF were treated with prolonged percutaneous drainage. Once a mature scar tract formed around the percutaneous drain, patients underwent a fistulojejunostomy.
  
  
  RESULTS
  The age of these patients ranged from 43 to 61 years. Of the 8 patients, 5 had fistulas secondary to necrotizing pancreatitis. The remaining 3 patients had fistulas resulting from previous pancreatic surgery. The average interval between drain placement and fistulojejunostomy was 6 months (range, 4-7 months). The average duration of operation was 2.5 h (range, 1-4.5 h). The average blood loss was 280 mL (range, 50-600 mL). Average duration of stay was 9 days (average, 4-14 days). At a mean follow-up of 17 months (range, 2-58 months), 6 of 8 patients had resolution of their pancreatic fistulas, could resume regular diet, and were free of narcotic use. One patient developed a recurrent pseudocyst and required a distal pancreatectomy, and the final patient was lost to follow-up.
  
  
  CONCLUSIONS
  Fistulojejunostomy is an effective therapy for the definitive treatment of pancreatic fistulas.
authors.affiliation: Department of Surgery, The University of Cincinnati Medical Center, Cincinnati, Ohio 45247, USA.
authors.forename: Rajalakshmi R
authors.initials: RR
authors.lastname: Nair
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Lowy
authors.forename: Benjamin
authors.initials: B
authors.lastname: McIntyre
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Sussman
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Matthews
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007582:Jejunostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000209:etiology / Q000601:surgery*; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications / Q000601:surgery*; D015607:Stents; D016896:Treatment Outcome