Two-Staged Pancreatoduodenectomy Including Interventional Pancreatic Fistulo-Jejunostomy in a High-Risk Patient

Context It has been reported that two-staged pancreatoduodenectomy including the first operation without pancreatoenteric anastomosis followed by later pancreatojejunostomy in the second operation is a safe method for high-risk patients. But this procedure requires twice laparotomy. Here we report an improved method to avoid the second operation using interventional technique. Case report A Seventyone- year-old man with a lower bile duct carcinoma who had repeated hemorrhage by duodenal ulcer and deterioration in the liver function underwent pancreatoduodenectomy. Because of the high risk situation, we selected the complete exteriorization of pancreatic juice without pancreatoenteric anastomosis to avoid pancreatic fistula. Three months after operation we performed interventional pancreatic fistulo-jejunostomy by puncturing the pancreatic fistula into the jejunal loop under endoscopic observation followed by insertion of 8Fr. internal drainage tube between pancreatic fistula and jejunum using double guide wires. Conclusion No complication occurred during and after procedure.