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01.09.2009 | Original article | Ausgabe 5/2009

Journal of Hepato-Biliary-Pancreatic Sciences 5/2009

Treatment of pancreatic fistula after pancreatoduodenectomy using a hand-made T-tube

Zeitschrift:
Journal of Hepato-Biliary-Pancreatic Sciences > Ausgabe 5/2009
Autoren:
Tsuyoshi Igami, Junichi Kamiya, Yukihiro Yokoyama, Hideki Nishio, Tomoki Ebata, Gen Sugawara, Yuji Nimura, Masato Nagino

Abstract

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.

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