Central pancreatectomy with inframesocolic pancreatojejunostomy.
OBJECTIVE
Pancreatic fistula (PF) occurs frequently after central pancreatectomy (CP), but it is not clear from which pancreatic stump it arises and, consequently, which interventions can reduce its incidence and severity. The information could be obtained if the two pancreatic remnants were segregated into different body compartments.


METHODS
In eight consecutive patients, the cut end of the distal pancreatic stump after CP was brought in the inframesocolic compartment through a small defect created in the transverse mesocolon. Pancreatojejunostomy was hence constructed in the intraperitoneal compartment, being divided by the retroperitoneal right-sided pancreatic stump by the transverse mesocolon itself. Five patients were operated on open, and three by robot-assisted laparoscopy. PF was defined according to the criteria proposed by the International Study Group on Pancreatic Fistula.


RESULTS
PF fistula developed in five out eight patients (three grade A and two grade B). Amylase concentration in the fluid obtained from surgical drains showed that the two pancreatic remnants were actually segregated into different body compartments and that four out of five PF originated from the right remnant. Mean hospital stay was 12.5 days. No patient was readmitted, developed peripancreatic fluid collections, required interventional radiology procedures, or underwent repeat surgery.


CONCLUSIONS
In CP, interposing an anatomic barrier, such as the transverse mesocolon, between the two pancreatic remnants is a simple maneuver that, if on one hand, adds little to the complexity of the operation, on the other, provides insights into the origin of PF after CP.
Division of General and Transplant Surgery, University of Pisa, Pisa, Italy. u.boggi@med.unipi.it
Ugo
U
Boggi
Gabriella
G
Amorese
Nelide
N
De Lio
Vittorio
V
Perrone
Simone
S
D'Imporzano
Chiara
C
Croce
Fabio
F
Vistoli
Stefano
S
Signori
Carla
C
Cappelli
Franco
F
Mosca
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D007902:Length of Stay; D008297:Male; D008646:Mesocolon / Q000601:surgery; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods*; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control*; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000601:surgery; D010193:Pancreaticojejunostomy / Q000379:methods*; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012371:Robotics; D012494:Sampling Studies; D016896:Treatment Outcome