Pancreas-preserving management of grade-C pancreatic fistula and a novel bridging technique for repeat pancreaticojejunostomy: An observational study

Abstract

External wirsungostomy may be a safe way to preserve the pancreas remnant in grade-C POPF patients. The novel bridging technique may be a simpler alternative to traditional PJ.

“Mitigation strategies for post-operative pancreatic fistula after pancreaticoduodenectomy in high-risk pancreas: an evidence-based algorithmic approach”—a narrative review

“…Other strategies include disconnection followed by exteriorization and bridge stenting may be used in some scenarios. Revising pancreaticoenteric anastomosis and switching to other techniques is not feasible in most of these scenarios and should not be done (141)(142)(143)(144)(145)(146)(147)(148)(149)(150).…”

Surgical Management of Postoperative Grade C Pancreatic Fistula following Pancreatoduodenectomy

“…Furthermore, it may be required after interventional bleeding control for hematoma evacuation and potentially focus control. During relaparotomy for grade C pancreatic fistula, the management of pancreatic stump includes different techniques and is classified as pancreas-preserving approaches or CP (Table 2) [12,[15][16][17][18][19][20][21][22][23][24]. Intraoperative findings frequently dictate the choice of the procedure, which is often determined by clinical instability and duration as well as bleeding and collateral damage risk of the procedure [17][18][19][21][22][23][24] (Table 3).…”

“…The free end of the catheter is passed through the abdominal wall and fixed to the skin, allowing drainage of fluids out of the abdomen (Fig. 3) [17,27]. Two drains are placed through the right and the left side in the abdominal cavity that are removed when the output is reduced to <50 mL/day.…”

“…Feeding jejunostomy can be performed in some patients, distal to the gastric enteric anastomosis to provide enteral nutrition. Total parenteral nutrition is indicated in all patients and should start as soon as possible [17][18][19][20][21]27]. Of the 21 patients who underwent wirsungostomy, 6 patients subsequently died of liver failure, refractory septic shock, or mesenteric ischemia (28.5%).…”

“…External wirsungostomy is a safe and feasible alternative associated with excellent long-term results, preserving pancreatic endocrine and exocrine functions. However, further validation is necessary to confirm its feasibility and safety [17,26,28]. Modified external wirsungostomy is the preferred approach in patients with a viable pancreatic stump.…”