Fistulojejunostomy Versus Distal Pancreatectomy for the Management of the Disconnected Pancreas Remnant Following Necrotizing Pancreatitis
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A disconnected distal pancreas (DDP) remnant is a morbid sequela of necrotizing pancreatitis. Definitive surgical management can be accomplished by either fistulojejunostomy (FJ) or distal pancreatectomy (DP). It is unclear which operative approach is superior with regard to short- and long-term outcomes.
Between 2002 and 2014, patients undergoing either FJ or DP for DDP were retrospectively identified at a center specializing in pancreatic diseases. Patient demographics, perioperative, and postoperative variables were evaluated.
Forty-two patients with DDP secondary to necrotizing pancreatitis underwent either a FJ (n = 21) or DP (n = 21). Between the two cohorts, there were no significant differences in overall lengths of stay, pancreatic leak rates, or readmission rates (all p > 0.05). DP was associated with higher estimated blood loss, increased transfusion requirements, and worsening endocrine function (all p < 0.05). At a median follow-up of 18 months, four patients that underwent a FJ developed a recurrent fluid collection requiring re-intervention. Overall, FJ was successful in 80% of patients as compared to a 95% success rate for DP (p = 0.15).
Although DP was associated with higher intraoperative blood loss, increased transfusion requirements, and worsening of preoperative diabetes, this procedure provides superior long-term resolution of a DDP when compared to FJ.
KeywordsNecrotizing pancreatitis Pancreatic duct disruption Disconnected duct syndrome Fistulojejunostomy Distal pancreatectomy
All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published in any other publication before its appearance in the Journal of Gastrointestinal Surgery.
Conception and design of study: VK Dhar, JM Sutton, GC Wilson, DE Abbott, and SA Ahmad
Acquisition of data: VK Dhar, JM Sutton, BT Xia, NC Levinsky, GC Wilson, M Smith, KA Choe, J Moulton, D Vu, and R Ristagno
Analysis and/or interpretation of data: VK Dhar, JM Sutton, JJ Sussman, MJ Edwards, DE Abbott, and SA Ahmad
Drafting the manuscript: VK Dhar, JM Sutton, DE Abbott, and SA Ahmad
Revising the manuscript critically for important intellectual content: VK Dhar, JM Sutton, BT Xia, NC Levinsky, GC Wilson, M Smith, KA Choe, J Moulton, D Vu, R Ristagno, JJ Sussman, MJ Edwards, DE Abbott, and SA Ahmad
Final approval of the version of the manuscript to be published: VK Dhar, JM Sutton, BT Xia, NC Levinsky, GC Wilson, M Smith, KA Choe, J Moulton, D Vu, R Ristagno, JJ Sussman, MJ Edwards, DE Abbott, and SA Ahmad
Agreement to be accountable for all aspects of the work: VK Dhar, JM Sutton, BT Xia, NC Levinsky, GC Wilson, M Smith, KA Choe, J Moulton, D Vu, R Ristagno, JJ Sussman, MJ Edwards, DE Abbott, and SA Ahmad
Compliance with Ethical Standards
Institutional Review Board approval was obtained prior to initiation of the study.
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