Embedding fistulojejunostomy: An easy and secure technique for refractory external pancreatic fistula.
BACKGROUND
Refractory external pancreatic fistula (REPF) is a rare but troublesome event. Fistulojejunostomy with direct suture of the fistula wall to jejunal wall has been demonstrated as a solution. However, it is sometimes technically difficult and some cases of failure were reported.


METHODS
An embedding fistulojejunostomy (EFJ) was designed. The fistula tract was detached from the abdominal wall and impactedly inserted into a Roux-en-Y jejunal lumen without direct suture of the fistula wall to the jejunal wall. Five patients with REPF for > 3 months underwent this procedure in the past 10 years. The preoperatively-placed drainage tubes temporarily exteriorized the pancreatic fluid for 30 days.


RESULTS
All fistulojejunostomy procedures were accomplished within 15 minutes. Four patients had uneventful recovery with a postoperative hospital stay ≤ 10 days. One patient had wound infection and needed hospitalization for 23 days. Except for one patient who required pancreatic enzyme supplements for 8 months, no other patient had pancreatic exocrine insufficiency. After follow up for 12-124 months, no patient required pancreatic enzyme supplements, and no patient had recurrent fistula or diabetes mellitus.


CONCLUSIONS
EFJ makes fistulojejunostomy easier and more secure with a satisfactory early and long-term outcome. It may be a desirable technique for REPF.
Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan.
Shao-Ciao
SC
Luo
Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan; Department of Surgery, Chung-Shan Medical University, Taichung 402, Taiwan.
Shao-Bin
SB
Cheng
Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan; Department of Surgery, Chung-Shan Medical University, Taichung 402, Taiwan; Department of Surgery, Faculty of Medicine, National Yang-Ming University, Taipei 112, Taiwan; Department of Surgery, Taipei Medical University, Taipei 110, Taiwan. Electronic address: he@vghtc.gov.tw.
Cheng-Chung
CC
Wu
Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan.
Chu-Chun
CC
Huang
Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan.
Yi-Ling
YL
Lin
Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan; Department of Surgery, Faculty of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
Fang-Ku
FK
P'eng
D000328:Adult; D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D015331:Cohort Studies; D017577:Cutaneous Fistula / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000175:diagnosis / Q000601:surgery; D010185:Pancreatic Fistula / Q000503:physiopathology / Q000601:surgery*; D010193:Pancreaticojejunostomy / Q000379:methods*; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
external pancreatic fistula; fistulojejunostomy