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01-07-2017 | Original Article

Fistulojejunostomy Versus Distal Pancreatectomy for the Management of the Disconnected Pancreas Remnant Following Necrotizing Pancreatitis

Authors: Vikrom K. Dhar, Jeffrey M. Sutton, Brent T. Xia, Nick C. Levinsky, Gregory C. Wilson, Milton Smith, Kyuran A. Choe, Jonathan Moulton, Doan Vu, Ross Ristagno, Jeffrey J. Sussman, Michael J. Edwards, Daniel E. Abbott, Syed A. Ahmad

Published in: Journal of Gastrointestinal Surgery | Issue 7/2017

Abstract

Background

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.

Methods

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.

Results

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).

Conclusions

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.

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Title: Fistulojejunostomy Versus Distal Pancreatectomy for the Management of the Disconnected Pancreas Remnant Following Necrotizing Pancreatitis
Authors: Vikrom K. Dhar
Jeffrey M. Sutton
Brent T. Xia
Nick C. Levinsky
Gregory C. Wilson
Milton Smith
Kyuran A. Choe
Jonathan Moulton
Doan Vu
Ross Ristagno
Jeffrey J. Sussman
Michael J. Edwards
Daniel E. Abbott
Syed A. Ahmad
Publication date: 01-07-2017
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 7/2017
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-017-3419-9

ACC 2024 Congress

Springer Medicine

Fistulojejunostomy Versus Distal Pancreatectomy for the Management of the Disconnected Pancreas Remnant Following Necrotizing Pancreatitis

Abstract

Background

Methods

Results

Conclusions

ACC 2024 Congress

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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