Roux-en-Y fistulojejunostomy in the management of persistent external pancreatic fistula: Is it olde worlde?
Gunjan Desai, Rajvilas Narkhede, Prasad Pande, Paresh Varty, Hitesh Mehta, Dattaprasanna Kulkarni
Department of Surgical Gastroenterology, Lilavati Hospital and Research Centre, Mumbai, India
Keywords: Fistula, necrosectomy, pancreas, pancreaticoduodenectomy, surgery
Objective: This article aims to identify the patient selection criteria and approach in treating persistent external pancreatic fistulas surgically with Roux-en-Y fistulojejunostomy, and it evaluates the outcomes of Roux-en-Y fistulojejunostomy with a review of the relevant literature.
Material and Methods: A retrospective data analysis from January 2010 to May 2017 revealed 6 patients who were managed with Roux-en-Y fistulojejunostomy for persistent external pancreatic fistulas, and their details were entered in a proforma. Standard surgical steps were performed in all patients, and the patients were followed up postoperatively for 1 year. Data were analyzed for outcomes, and the literature was reviewed.
Results: Four of 6 patients had persistent external pancreatic fistulas following pancreatic necrosectomy, 1 had surgery for pancreatic pseudocyst, and 1 after pancreaticoduodenectomy for pancreatic head mass. An average duration of conservative management was 14 weeks, and Roux-en-Y fistulojejunostomy was performed at a median distance of 6 cm from pancreas via a midline laparotomy. All patients recovered without major complications. Only 1 patient developed diabetes at a 1-year follow-up.
Conclusion: Fistulojejunostomy is a safe and effective treatment for persistent pancreatic fistula having the benefit of avoiding a difficult major pancreatic resectional surgery in an already debilitated patient with frozen tissue planes, along with low postoperative morbidity and mortality. The short- and mid-term outcomes in the literature for this procedure are good, as it has also been seen in our study on diverse indications.
Cite this paper as: Desai G, Narkhede R, Pande P, Varty P, Mehta H, Kulkarni D. Roux-en-Y fistulojejunostomy in the management of persistent external pancreatic fistula: Is it olde worlde?. Turk J Surg 2018; 10.5152/turkjsurg.2018.4110.
This study was presented at the “Indian Chapter of the International Hepato-Pancreato-Biliary Association (IHPBA India)”, “January 28-31, 2016”, “Ahmedabad, India”.
Ethics committee approval was received for this study from the Ethics Committee of Lilavati Hospital and research Centre.
Written informed consent was obtained from all the patients who participated in this study.
Concept - D.K., H.M., P.V.; Design - G.D., R.N., P.P.; Supervision - H.M., P.V., D.K.; Resource - R.N., P.P., G.D.; Materials - G.D., R.N., P.P.; Data Collection and/or Processing - P.V., D.K., H.M.; Analysis and/or Interpretation - D.K., H.M., P.V.; Literature Search - P.P., G.D., R.N.; Writing Manuscript - G.D., R.N., P.P.; Critical Reviews - D.K., H.M., P.V.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.