A postoperative clinically relevant pancreatic fistula can cause severe sequelae. We aimed to describe our minimally invasive procedure (rendezvous technique) for the treatment of a pancreatic fistula resulting from pancreaticojejunal anastomosis dehiscence involving a dislodged main pancreatic duct tube.
In our rendezvous technique, a guidewire is advanced into the jejunal lumen from the access site of the drainage tube and is caught by a snare catheter, which is used to replace the dislodged main pancreatic duct tube. Then, the guidewire is passed from the access site of the drainage tube to the site of the dislodged main pancreatic duct tube. A sheath is inserted along the route of the dislodged main pancreatic duct tube and is placed across the pancreaticojejunal anastomosis over the guidewire. Another guidewire is advanced into the main pancreatic duct via the sheath, and a new main pancreatic duct tube is inserted into the main pancreatic duct over the second wire. This technique was performed in two patients with a pancreatic fistula.
Our rendezvous technique was successfully performed in a 73-year-old man with an intractable clinically relevant pancreatic fistula and large discharge from the drain and a 74-year-old woman with a pancreatic fistula and fluid collection between the elevated jejunum and remnant pancreas. Discharge from the drain and fluid collection decreased after the procedure.
Our rendezvous technique is an effective minimally invasive approach for a pancreatic fistula resulting from pancreaticojejunal anastomosis dehiscence.
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Hackert T, Werner J, Buchler MW. Postoperative pancreatic fistula. Surgeon. 2011;9:211–7.
Nahm CB, Connor SJ, Samra JS, Mittal A. Postoperative pancreatic fistula: a review of traditional and emerging concepts. Clin Exp Gastroenterol. 2018;11:105–18.
Hackert T, Hinz U, Pausch T, Fesenbeck I, Strobel O, Schneider L, et al. Postoperative pancreatic fistula: we need to redefine grades B and C. Surgery. 2016;159:872–7.
Pedrazzoli S. Pancreatoduodenectomy (PD) and postoperative pancreatic fistula (POPF): a systematic review and analysis of the POPF-related mortality rate in 60,739 patients retrieved from the English literature published between 1990 and 2015. Medicine (Baltimore). 2017;96:e6858.
Casadei R, Ricci C, Giampalma E, D’Ambra M, Taffurelli G, Mosconi C, et al. Interventional radiology procedures after pancreatic resections for pancreatic and periampullary diseases. JOP. 2014;15:378–82.
Bassi C, Marchegiani G, Dervenis C, Sarr M, Abu Hilal M, Adham M, et al. The 2016 update of the international study group (ISGPS) definition and grading of postoperative pancreatic fistula: 11 years after. Surgery. 2017;161:584–91.
Motoi F, Egawa S, Rikiyama T, Katayose Y, Unno M. Randomized clinical trial of external stent drainage of the pancreatic duct to reduce postoperative pancreatic fistula after pancreaticojejunostomy. Br J Surg. 2012;99:524–31.
Pessaux P, Sauvanet A, Mariette C, Paye F, Muscari F, Cunha AS, et al. External pancreatic duct stent decreases pancreatic fistula rate after pancreaticoduodenectomy: prospective multicenter randomized trial. Ann Surg. 2011;253:879–85.
Poon RT, Fan ST, Lo CM, Ng KK, Yuen WK, Yeung C, et al. External drainage of pancreatic duct with a stent to reduce leakage rate of pancreaticojejunostomy after pancreaticoduodenectomy: a prospective randomized trial. Ann Surg. 2007;246:425–33 (discussion 433–5).
Yamazaki S, Kuramoto K, Itoh Y, Watanabe Y, Ueda T. A minimally invasive approach for postoperative pancreatic fistula. Cardiovasc Intervent Radiol. 2003;26:580–2.
Lucatelli P, Sacconi B, Cereatti F, Argiro R, Corona M, Bezzi M, et al. Combined endoscopic-radiological rendezvous for distal tail postoperative pancreatic fistula (POPF). Cardiovasc Intervent Radiol. 2016;39:1327–31.
Imai D, Yamashita Y, Ikegami T, Toshima T, Harimoto N, Yoshizumi T, et al. A “rendezvous technique” for treating a pancreatic fistula after distal pancreatectomy. Surg Today. 2015;45:96–100.
We present a report of a case at the Cardiovascular and Interventional Radiological Society of Europe 2018.
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study, and this study has obtained IRB approval.
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Suyama, Y., Hoshikawa, M., Yoshikawa, H. et al. Restoration of Dehiscent Pancreaticojejunostomy Causing a Major Postoperative Pancreatic Fistula by Reinsertion of a Pancreatic Duct Tube Using the Rendezvous Technique. Cardiovasc Intervent Radiol 42, 1358–1362 (2019). https://doi.org/10.1007/s00270-019-02228-3
- Rendezvous technique
- Pancreatic fistula