1. Embedding fistulojejunostomy: An easy and secure technique for refractory external pancreatic fistula
- Author
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Shao-Bin Cheng, Fang-Ku P’eng, Chu-Chun Huang, Cheng-Chung Wu, Yi-Ling Lin, and Shao-Ciao Luo
- Subjects
Adult ,Male ,medicine.medical_specialty ,external pancreatic fistula ,Fistula ,Cutaneous Fistula ,lcsh:Surgery ,030230 surgery ,Risk Assessment ,Abdominal wall ,Cohort Studies ,03 medical and health sciences ,Pancreatic Fistula ,0302 clinical medicine ,Postoperative Complications ,Refractory ,Suture (anatomy) ,Recurrence ,Pancreaticojejunostomy ,medicine ,Humans ,fistulojejunostomy ,Aged ,Retrospective Studies ,business.industry ,Pancreatic exocrine insufficiency ,Jejunal wall ,Pancreatic Diseases ,Retrospective cohort study ,Anastomosis, Roux-en-Y ,lcsh:RD1-811 ,Middle Aged ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Pancreatic fistula ,Drainage ,030211 gastroenterology & hepatology ,Female ,business ,Follow-Up Studies - Abstract
Summary 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. Conclusion EFJ makes fistulojejunostomy easier and more secure with a satisfactory early and long-term outcome. It may be a desirable technique for REPF.
- Published
- 2016