Pancreas-preserving management of grade-C pancreatic fistula and a novel bridging technique for repeat pancreaticojejunostomy: An observational study.
PURPOSE
Optimal surgical strategy for grade-C postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) is not justified. External wirsungostomy is feasible. However, the subsequent repeat pancreaticojejunostomy (PJ) is challenging. This study aims to introduce our experience of external wirsungostomy for grade-C POPF and a novel technique to do the repeat PJ (re-PJ).


MATERIALS AND METHODS
From January 1, 2012 to December 31, 2016, all consecutive patients who underwent pancreaticoduodenectomy (PD) with PJ were identified. The clinical data were retrospectively collected and analyzed.


RESULTS
Out of 325 patients, 11 patients (3.38%) underwent salvage re-laparotomy for grade-C POPF. External wirsungostomy was performed in 10 patients (3.08%). Four patients died of severe complications within 90 days postoperatively or tumor progression before the scheduled re-PJ was performed. Three patients got their external pancreatic drainage tube pulled out accidentally without causing severe consequences. Three patients underwent planned re-PJ after external wirsungostomy, including one with duct-to-mucosa PJ and two with the novel bridging technique. The operative times of the two patients undergoing the novel bridging technique were 120 min, 135 min, respectively, and the length of post-operative hospital stay (LPHS) were 7 d, 5 d, respectively. The operative time and the LPHS of whom underwent duct-to-mucosa PJ were 315 min, 24 d, respectively. There was no major post-operative complication.


CONCLUSION
External wirsungostomy may be a safe way to preserve the pancreas remnant in grade-C POPF patients. The novel bridging technique may be a simpler alternative to traditional PJ.
['Ma|Tao|T|', 'Bai|Xueli|X|', 'Chen|Wen|W|', 'Li|Guogang|G|', 'Lao|Mengyi|M|', 'Liang|Tingbo|T|']
D000328:Adult D000368:Aged D000714:Anastomosis, Surgical D001661:Biliary Tract Neoplasms D004322:Drainage D004379:Duodenal Neoplasms D005260:Female D006801:Humans D007813:Laparotomy D007902:Length of Stay D008297:Male D008875:Middle Aged D061646:Operative Time D010183:Pancreatic Ducts D010185:Pancreatic Fistula D010190:Pancreatic Neoplasms D016577:Pancreaticoduodenectomy D010193:Pancreaticojejunostomy D011183:Postoperative Complications D012086:Reoperation D012189:Retrospective Studies D016879:Salvage Therapy
Pancreatic fistula Pancreaticojejunostomy Pancreaticoduodenectomy External wirsungostomy Reoperation