Turkish Journal of Surgery

Turkish Journal of Surgery

ISSN: 2564-6850
e-ISSN: 2564-7032

 

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

Abstract

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

Ethics committee approval was received for this study from the Ethics Committee of Lilavati Hospital and research Centre.

Peer Review

Externally peer-reviewed.

Author Contributions

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.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.