title: Pancreaticojejunostomy Stricture After Pancreatoduodenectomy: Outcomes After Operative Revision.
abstract: BACKGROUND
  The natural history of radiographic strictures of the pancreaticojejunostomy (PJ) after pancreatoduodenectomy (PD) is difficult to characterize. The purpose of this study was to identify the indications for operative revision of PJ strictures after PD for benign and malignant disease and to evaluate its safety and clinical efficacy.
  
  
  METHODS
  A retrospective review of all patients undergoing operative revision of PJ strictures following PD at a single academic institution over an 8-year period (2006-2014) was performed.
  
  
  RESULTS
  Twenty-seven patients underwent revision of a symptomatic radiographically detectable PJ stricture. The median time from PD to PJ stricture diagnosis was 46 months. The median increase in the main pancreatic duct diameter between the time of PD and PJ revision was 2 mm. The overall morbidity after PJ revision was 26 %. No postoperative mortality occurred. Twenty-one (78 %) patients experienced resolution of symptoms without recurrent acute pancreatitis after PJ revision during a median follow-up of 30 months. Durable symptom resolution was reported among 60 % of patients with chronic pancreatitis.
  
  
  CONCLUSIONS
  Surgical revision of pancreaticojejunostomy strictures is technically safe and clinically effective for selected patients who experience recurrent acute pancreatitis after pancreatoduodenectomy for either benign or malignant disease.
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 513, Indianapolis, IN, 46202, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Cioffi
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 513, Indianapolis, IN, 46202, USA.
authors.forename: Lucas A
authors.initials: LA
authors.lastname: McDuffie
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 513, Indianapolis, IN, 46202, USA.
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Roch
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 513, Indianapolis, IN, 46202, USA.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Zyromski
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 513, Indianapolis, IN, 46202, USA.
authors.forename: Eugene P
authors.initials: EP
authors.lastname: Ceppa
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 513, Indianapolis, IN, 46202, USA.
authors.forename: C Max
authors.initials: CM
authors.lastname: Schmidt
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 513, Indianapolis, IN, 46202, USA.
authors.forename: Attila
authors.initials: A
authors.lastname: Nakeeb
authors.affiliation: Department of Surgery, Indiana University School of Medicine, 545 Barnhill Drive, EH 513, Indianapolis, IN, 46202, USA. michouse@iupui.edu.
authors.forename: Michael G
authors.initials: MG
authors.lastname: House
mesh_terms: D000328:Adult; D000368:Aged; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010193:Pancreaticojejunostomy / Q000009:adverse effects*; D050500:Pancreatitis, Chronic / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Pancreaticojejunostomy revision; Pancreaticojejunostomy stricture; Pancreatoduodenectomy