Abstract
Background: Disconnected pancreatic duct syndrome (DPDS), a severe complication of acute necrotizing pancreatitis (ANP) can require surgery, usually by distal pancreatectomy, but frequently exposing to diabetes. We describe a new technique reconnecting the distal pancreas to the digestive tract. Methods: This technique was proposed for DPDS in non-diabetic or non-insulin dependent diabetic patients with a distal pancreas exceeding 5 cm. The ruptured zone was identified and the distal side was anastomosed to the stomach or the jejunum. Results: From 2013 to June 2019, 36 patients (median=49 years), underwent the “French reconnection”, indicated for chronic pain/recurrent pancreatitis (35;97%), persistent pancreatic fistula (33; 92%), or digestive compression/fistulisation (9; 25%). Preoperatively, median weight loss was 10 kg (4-27), median number of hospitalisation per patient was 5(1-8) and 24(67%) patients received endoscopic/percutaneous treatment. Surgery was performed after a median delay of 279(90-2000) days after ANP, through laparoscopy in 9 (25%) patients. The remnant pancreas (median length=70mm; 50-130) was anastomosed to the stomach (n=30) or the jejunum (n=6). Postoperatively, there were 13(39%) grade B/C pancreatic fistulas and 3 (10%) bleedings including one lethal (mortality=3%). Median hospital stay was 18(7-121) days. With a median follow up of 24(4-53) months, all pancreatic fistulas healed and the clinical success rate was 91%. Median BMI increased from 22 to 25 kg/m2. Postoperative endocrine and severe exocrine insufficiencies were observed in 4 (15%) and 7(32%) patients, respectively. Conclusions: The “French reconnection” is a good alternative to distal pancreatectomy for DPDS, allowing excellent control of symptoms and preserving pancreatic function.
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