Surgical revision for pancreatojejunostomy stricture: a case series of 14 patients.

Abstract

BACKGROUND:

Pancreatojejunostomy stricture (PJS) is a rare long-term complication of pancreaticojejunal anastomosis. This study aimed to investigate the role of surgery in the management of pancreatojejunostomy strictures.

METHODS:

The database of the Pancreas Center of Nanjing Medical University was retrospectively screened for patients who underwent a surgical revision for PJS between June 2012 and August 2019, and their clinical characteristics and management modalities were reviewed.

RESULTS:

Fourteen consecutive cases were retrieved, the median age at index operation was 41.1 years (19-71). The average time between the two operations was 70.6 months (8-270 months). Index procedures included pancreaticoduodenectomy (PD) (7/14, 50%), pylorus-preserving PD (4/14, 28.6%), Berger procedure (2/14, 14.3%), and middle pancreatectomy (1/14, 7.1%). The diameter of the main pancreatic duct was < 4 mm in all 14 cases, and nine underwent pancreaticojejunostomy (PJ) stenting during the index operation. The most frequent complaints were abdominal pain (6/14, 42.9%), recurrent acute pancreatitis (6/14, 42.9%), pancreatic fistula (1/14, 7.1%), and abdominal distention (1/14, 7.1%). The diagnosis of PJ stricture was confirmed by computed tomography or magnetic resonance imaging in all cases. All patients had a main duct diameter > 5 mm before surgical revision. All patients underwent wedge excision with interrupted one-layer suturing with absorbable sutures and without stent placement. In this series, only one patient required reoperation. Upon follow-up, 11 of 12 patients had complete resolution of the PJ stricture.

CONCLUSION:

PJS is a long-term complication of pancreatojejunostomy. Surgical revision of the anastomosis is a safe and effective treatment modality.

• Authors: Feng Guo, Shimeng Huang, Tewodross Getu Wolde, Zipeng Lu, Jianmin Chen, Junli Wu, Wentao Gao, Kuirong Jiang, Yi Miao, Jishu Wei
• Journal: BMC surgery (BMC Surg) Vol. 22 Issue 1 Pg. 318 (Aug 19 2022) ISSN: 1471-2482 [Electronic] England
• PMID: 35982438 (Publication Type: Journal Article)
• Copyright: © 2022. The Author(s).

Topics

• Acute Disease
• Anastomosis, Surgical (adverse effects)
• Constriction, Pathologic (complications, surgery)
• Humans
• Pancreatic Fistula
• Pancreaticoduodenectomy (adverse effects, methods)
• Pancreaticojejunostomy (adverse effects, methods)
• Pancreatitis
• Postoperative Complications (etiology, surgery)
• Reoperation (adverse effects)
• Retrospective Studies