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Treatment of pancreatic fistula after pancreatoduodenectomy using a hand‐made T‐tube
Author(s) -
Igami Tsuyoshi,
Kamiya Junichi,
Yokoyama Yukihiro,
Nishio Hideki,
Ebata Tomoki,
Sugawara Gen,
Nimura Yuji,
Nagino Masato
Publication year - 2009
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s00534-009-0104-8
Subject(s) - medicine , tube (container) , surgery , pancreatic duct , pylorus , pancreatic fistula , fistula , pancreas , gastroenterology , pancreatitis , stomach , mechanical engineering , engineering
Background/Purpose To describe a technique for the treatment of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) using a hand‐made T‐tube. Methods Reconstruction after PD was performed by a modified Child's method. A 3‐mm tube and a 2‐mm tube were connected in a ‘T’ shape. This hand‐made T‐tube was inserted into both the pancreatic duct and the jejunal limb, using two guidewires through a sinus tract of POPF. After a few days, the external end of the T‐tube was closed with a metallic tip, and the internal pancreatic drainage was completed. Results The indication criteria for the T‐tube treatment are as follows: (1) the pancreatic drainage tube inserted during operation has been dislodged; and (2) either the main pancreatic duct or the jejunal limb can be demonstrated on fistulograms. In the 30 years between 1978 and 2007, 642 patients underwent PD (pylorus‐preserving, n = 210; Whipple, n = 302; and hepatopancreatoduodenectomy, n = 130). The T‐tube treatment was performed in 9 patients (pylorus‐preserving, n = 5; Whipple, n = 1; and hepatopancreatoduodenectomy, n = 3). The median duration between surgery and the T‐tube placement was 64 days (range, 22–107 days). The median hospital stay after the T‐tube placement was 12 days (range, 7–54 days). Neither major nor minor complications associated with the T‐tube treatment occurred. The T‐tube was removed in 5 patients after a median of 2 months (range, 2–24 months). Of these patients, 4 are alive without recurrence of carcinoma, and 1 patient died of recurrence 56 months after surgery. The other 4 patients died of recurrence before removal of the T‐tube, at 11 months after placement of the tube (range, 7–15 months) without any complications associated with the T‐tube treatment. Conclusions T‐tube treatment is a minimally invasive, simple, safe, and reliable technique that can dramatically improve grade C POPF. This procedure should be considered as a first‐line treatment of choice in selected patients with refractory grade C POPF.