title: Fistulojejunostomy Versus Distal Pancreatectomy for the Management of the Disconnected Pancreas Remnant Following Necrotizing Pancreatitis.
abstract: A disconnected distal pancreas (DDP) remnant is a morbid sequela of necrotizing pancreatitis. Definitive surgical management can be accomplished by either fistulojejunostomy (FJ) or distal pancreatectomy (DP). It is unclear which operative approach is superior with regard to short- and long-term outcomes.
  
  
  
  Between 2002 and 2014, patients undergoing either FJ or DP for DDP were retrospectively identified at a center specializing in pancreatic diseases. Patient demographics, perioperative, and postoperative variables were evaluated.
  
  
  
  Forty-two patients with DDP secondary to necrotizing pancreatitis underwent either a FJ (n = 21) or DP (n = 21). Between the two cohorts, there were no significant differences in overall lengths of stay, pancreatic leak rates, or readmission rates (all p > 0.05). DP was associated with higher estimated blood loss, increased transfusion requirements, and worsening endocrine function (all p < 0.05). At a median follow-up of 18 months, four patients that underwent a FJ developed a recurrent fluid collection requiring re-intervention. Overall, FJ was successful in 80% of patients as compared to a 95% success rate for DP (p = 0.15).
  
  
  
  Although DP was associated with higher intraoperative blood loss, increased transfusion requirements, and worsening of preoperative diabetes, this procedure provides superior long-term resolution of a DDP when compared to FJ.
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0558, SRU Room 1466, Cincinnati, OH, 45219, USA.
authors.forename: Vikrom K
authors.initials: VK
authors.lastname: Dhar
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0558, SRU Room 1466, Cincinnati, OH, 45219, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Sutton
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0558, SRU Room 1466, Cincinnati, OH, 45219, USA.
authors.forename: Brent T
authors.initials: BT
authors.lastname: Xia
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0558, SRU Room 1466, Cincinnati, OH, 45219, USA.
authors.forename: Nick C
authors.initials: NC
authors.lastname: Levinsky
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0558, SRU Room 1466, Cincinnati, OH, 45219, USA.
authors.forename: Gregory C
authors.initials: GC
authors.lastname: Wilson
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Milton
authors.initials: M
authors.lastname: Smith
authors.affiliation: Department of Radiology, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Kyuran A
authors.initials: KA
authors.lastname: Choe
authors.affiliation: Department of Radiology, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Moulton
authors.affiliation: Department of Radiology, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Doan
authors.initials: D
authors.lastname: Vu
authors.affiliation: Department of Radiology, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Ross
authors.initials: R
authors.lastname: Ristagno
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0558, SRU Room 1466, Cincinnati, OH, 45219, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Sussman
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0558, SRU Room 1466, Cincinnati, OH, 45219, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Edwards
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Wisconsin, Madison, WI, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.affiliation: Department of Surgery, Division of Surgical Oncology, University of Cincinnati Medical Center, 231 Albert Sabin Way, ML 0558, SRU Room 1466, Cincinnati, OH, 45219, USA. ahmadsy@uc.edu.
authors.forename: Syed A
authors.initials: SA
authors.lastname: Ahmad
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D016063:Blood Loss, Surgical; D005260:Female; D006801:Humans; D007582:Jejunostomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery; D010180:Pancreatectomy / Q000009:adverse effects*; D019283:Pancreatitis, Acute Necrotizing / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Disconnected duct syndrome; Distal pancreatectomy; Fistulojejunostomy; Necrotizing pancreatitis; Pancreatic duct disruption