Fistulojejunostomy for the management of refractory pancreatic fistula.
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.
Nair
Rajalakshmi R
RR
Department of Surgery, The University of Cincinnati Medical Center, Cincinnati, Ohio 45247, USA.
Lowy
Andrew M
AM
McIntyre
Benjamin
B
Sussman
Jeffrey J
JJ
Matthews
Jeffrey B
JB
Ahmad
Syed A
SA
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