Promoting Pancreatic Fistula Healing After Pancreaticoduodenectomy Through Internal Drainage of Pancreatic Juice Into the Jejunum.

BACKGROUND

Postoperative pancreatic fistula (POPF) is a significant complication of pancreaticoduodenectomy (PD), leading to severe morbidity and prolonged hospitalization. Drain-tract-targeted management and fistulography are important in the treatment of clinically relevant POPF. However, the healing process for POPF remains unclear.

METHODS

A retrospective analysis was conducted on 63 patients who underwent pancreaticojejunostomy at our institution between 2017 and 2022 and underwent fistulography at least twice. The patients were classified by drain contrast type into (1) the fistulous tract (FT) group (n = 12), where only the fistula was contrasted or (2) the fluid collection (FC) group (n = 51), where the FC was connected to the drain fistula. The postoperative outcomes, including POPF resolution and drainage duration, were compared between the two groups.

RESULTS

The incidence of POPF (International Study Group on Pancreatic Fistula grades BL, B, and C) was comparable between the FT (91.6%) and FC (94.1%, p = 0.53) groups. More patients in the FC group (60.8%) achieved POPF resolution through drainage into the jejunum than in the FT group (16.7%, p < 0.001). The median drainage duration was significantly shorter in the FT group (22.5 days; interquartile range [IQR], 16.1-24.3) than in the FC group (28.0 days; IQR, 21.5-33.5; p = 0.011). More drain exchanges were required in the FC group (median, 4; IQR, 3.0-5.0) than in the FT group (median, 3; IQR, 2.0-3.3; p = 0.01). All patients in the jejunal drainage group followed the same course: after fistulography showed that contrast was flowing into the jejunum, the drainage fluid decreased, and the drains were eventually removed. Readmission, intra-abdominal abscess, or re-drainage after drain removal was not observed.

CONCLUSION

Internal drainage into the jejunum significantly improved POPF healing after PD. This study highlights the importance of monitoring and managing drainage patterns using fistulography.