Roux-en-Y internal drainage is the best surgical option to treat patients with disconnected duct syndrome after severe acute pancreatitis

Abstract

Background. Roux-en-Y (RNY) internal drainage has been our primary surgical strategy to definitively treat disconnected duct syndrome in patients after severe acute pancreatitis (SAP). This study compares the results of internal drainage with the results of distal pancreatectomy-splenectomy (DPS) performed in a contemporaneous group of patients. Methods. For 5 years (June 1995 to June 2000), 27 consecutive patients with disconnected duct syndrome after SAP were identified: 13 treated with internal drainage and 14 with DPS. Fistula characteristics, operative management, and clinical outcome were analyzed. Comparisons between groups were made with the Student t test and Fisher exact test, with statistical significance defined as P <.05. Results. Age, sex, etiology of pancreatitis, comorbid diseases, and prior operations were similar between groups. Internal drainage required less operative time (211 ± 37 vs 269 ± 88 minutes, P =.04), blood loss (735 ± 706 vs 2757 ± 3062 mL, P =.03), and transfusion requirements (0.69 ± 1.7 vs 4.21 ± 8.0 units, P =.05). Clinical outcomes—as measured by postoperative complication rate, reoperation rate, fistula recurrence rate, and death rate—were similar between groups. Conclusions. RNY internal drainage, when technically feasible, is the best surgical option to treat disconnected duct syndrome after SAP. (Surgery 2001;130:714-21.)