Embedding fistulojejunostomy: An easy and secure technique for refractory external pancreatic fistula

作者：Luo Shao Ciao; Cheng Shao Bin; Wu Cheng Chung^*; Huang Chu Chun; Lin Yi Ling; P'eng Fang Ku

来源：Asian Journal of Surgery, 2018, 41(2): 143-147.

DOI：10.1016/j.asjsur.2016.09.005

• external pancreatic fistula
• fistutojejunostomy

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.

• 出版日期2018-3