Long-term outcome of rendezvous internalization treatment for external pancreatic fistulas associated with disconnected pancreatic duct syndrome: a retrospective study.

objectiveWalled-off pancreatic necrosis resulting from severe necrotizing pancreatitis often leads to complications, including disconnected pancreatic duct syndrome (DPDS) and the subsequent development of external pancreatic fistulas (EPFs). This study aimed to evaluate the long-term outcome of rendezvous internalization treatment for EPF associated with DPDS.

methodsA retrospective review of 40 patients with EPFs secondary to DPDS who underwent rendezvous treatment between October 2008 and October 2023 was conducted. Three techniques were utilized: outside-in (n = 18), inside-out (n = 19), and pancreatic duct bridging (n = 3). Primary outcomes included the rate of surgery post-treatment, while secondary outcomes encompassed recurrence of peripancreatic fluid collection (PFC) or EPF.

resultsThe mean age of patients was 54.6 years, with 67.5% being male. Gallstones (37.5%) and alcohol (25.0%) were the leading etiologies. The median time from pancreatitis onset to the procedure was 216 days. All patients achieved EPF closure, with a median closure time of 20 days. Procedure-related complications included post-procedural acute pancreatitis (12.5%) and minor bleeding (7.5%), with no perforations or mortality. During a median follow-up of 53.5 months, recurrence of EPF occurred in three patients (7.5%), with two requiring surgery (5.0%). Recurrence of PFC (22.5%) and acute pancreatitis (17.5%) were also observed. New-onset diabetes mellitus occurred in 50% of patients.

conclusionRendezvous internalization treatments are highly effective for EPFs associated with DPDS, achieving high closure rates and low recurrence. These findings underscore their potential to reduce surgical necessity. Prospective studies are warranted to optimize strategies for these challenging cases.