title: Treatment of pancreatic fistula after pancreatoduodenectomy using a hand-made T-tube.
abstract: OBJECTIVE
  To describe a technique for the treatment of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) using a hand-made T-tube.
  
  
  METHODS
  Reconstruction after PD was performed by a modified Child's method. A 3-mm tube and a 2-mm tube were connected in a 'T' shape. This hand-made T-tube was inserted into both the pancreatic duct and the jejunal limb, using two guidewires through a sinus tract of POPF. After a few days, the external end of the T-tube was closed with a metallic tip, and the internal pancreatic drainage was completed.
  
  
  RESULTS
  The indication criteria for the T-tube treatment are as follows: (1) the pancreatic drainage tube inserted during operation has been dislodged; and (2) either the main pancreatic duct or the jejunal limb can be demonstrated on fistulograms. In the 30 years between 1978 and 2007, 642 patients underwent PD (pylorus-preserving, n = 210; Whipple, n = 302; and hepatopancreatoduodenectomy, n = 130). The T-tube treatment was performed in 9 patients (pylorus-preserving, n = 5; Whipple, n = 1; and hepatopancreatoduodenectomy, n = 3). The median duration between surgery and the T-tube placement was 64 days (range, 22-107 days). The median hospital stay after the T-tube placement was 12 days (range, 7-54 days). Neither major nor minor complications associated with the T-tube treatment occurred. The T-tube was removed in 5 patients after a median of 2 months (range, 2-24 months). Of these patients, 4 are alive without recurrence of carcinoma, and 1 patient died of recurrence 56 months after surgery. The other 4 patients died of recurrence before removal of the T-tube, at 11 months after placement of the tube (range, 7-15 months) without any complications associated with the T-tube treatment.
  
  
  CONCLUSIONS
  T-tube treatment is a minimally invasive, simple, safe, and reliable technique that can dramatically improve grade C POPF. This procedure should be considered as a first-line treatment of choice in selected patients with refractory grade C POPF.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Igami
authors.forename: Junichi
authors.initials: J
authors.lastname: Kamiya
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Yokoyama
authors.forename: Hideki
authors.initials: H
authors.lastname: Nishio
authors.forename: Tomoki
authors.initials: T
authors.lastname: Ebata
authors.forename: Gen
authors.initials: G
authors.lastname: Sugawara
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
mesh_terms: D000368:Aged; D015331:Cohort Studies; D020878:Device Removal; D004322:Drainage / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000628:therapy; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome