Salvage anastomosis for postoperative chronic pancreatic fistula

Abstract

Salvage anastomosis for postoperative chronic pancreatic fistula is challenging, and its safety and surgical outcomes remain unclear. Four patients with postoperative chronic pancreatic fistulas who underwent surgical interventions in our institute were retrospectively reviewed. A re-pancreatojejunostomy was performed in two patients with a disruption of the pancreatojejunostomy and a dilated main pancreatic duct of the remnant pancreas. A fistulojejunostomy was performed in the remaining two patients with a duct disruption after necrosectomy for necrotic severe acute pancreatitis and non-dilated main pancreatic duct. The median duration from the onset of the pancreatic fistula to the surgical intervention was 4.5 months (range 4-6 months). The median operation time was 151 min (range 38-257 min) and the median blood loss was 200 mL (range 5-350 mL). According to the Clavien-Dindo classification, one patient had grade 0, two patients had grade I, and one patient had grade II (wound infections). The median length of hospital stay was 22 days (range 21-28 days). There were no recurrences of pancreatic fistulas. Salvage anastomosis according to the simple radiologic classification for postoperative chronic pancreatic fistulas is a safe and effective procedure.

Keywords: Fistulojejunostomy; Pancreatic fistula; Pancreatojejunostomy; Surgical management.