Internal pancreatic fistula with pancreatic ascites in chronic pancreatitis: diagnosis and surgical management

Abstract

Background: Internal pancreatic fistula with pancreatic ascites (IPF PA) is an uncommon but well-known complication of chronic pancreatitis (CP) followed by significant morbidity and mortality [1, 2]. The aim of the present study is to evaluate the efficiency of different ways of diagnosis and surgical management in patients with IPF PA. Methods: We have prospectively analyzed 29 patients with IPF PA who underwent surgical treatment. Patients’ data, diagnostic’s findings, surgical procedures, postoperative complications and survival have been analyzed. Additionally, quality of life has been assessed using the MOS SF-36 questionnaire. Results: The current study has revealed a good performance (93.1%) of diagnostic algorithm (laparocentesis, CT, MRCP, ERCP) for determination of IPF PA. 25 patients underwent Frey’s procedure, 3 – cystopancreatojejunal anastomosis using Roux-en-Y loop, 1 - combination of Frey’s procedure and cystopancreatojejunal anastomosis using the same Roux-en-Y loop. Total morbidity and mortality were 10.3% and 3.5% respectively. We admitted improvement in comparison of life quality before the surgery and after 12 - 24 months (p < 0.01). Mortality and relapse of ascites weren't observed during this period; the endocrine insufficiency was revealed in one patient. Conclusion: Surgical treatment proves to be the effective and safe option for patients suffering from CP with pancreatic ascites with the significant subsequent improvement in their quality of life.