An alternative surgery for an atypical kind of grade C postoperative pancreatic fistula following pancreaticoduodenectomy

BACKGROUND/AIM: Grade C postoperative pancreatic fistula (POPF) is a life-threatening complication of pancreaticoduodenectomy (PD), with its surgical management remaining under debate. Occasionally, POPF is associated with a compromised anastomotic Roux-limb. Our series focused to this sort of grade C mixed fistula. PATIENTS AND METHODS: Between April 2004 and March 2014, 5 out of 12 patients with grade C POPF were classified as grade C mixed POPFs. Surgery consisted of associating resection of the anastomotic jejunal segment with resection and closure of the pancreatic stump. RESULTS: Four patients suffered from a grade C mixed POPF discharging into a single dehiscent site; 1 patient was found with two dehiscent points in all (pancreatic anastomosis and jejunal rim). For all of them, the described surgical procedure resulted in complete recovery. CONCLUSION: For grade C pancreatico-digestive POPF, resecting anastomotic jejunal segment during dismantling of the pancreatico-digestive anastomosis appears a very promising surgical technique.