Stent-bridging fistulogastrostomy for refractory post-pancreatectomy external pancreatic fistula

External pancreatic fistula (EPF) is a common consequence of partial pancreatectomy or percutaneous treatments for infected pancreatic necrosis. It has traditionally been treated surgically with distal pancreatectomy, Roux-en-Y pancreaticoenterostomy, or fistuloenterostomy.

This study introduces a novel technique of laparoscopic stent-bridging fistulogastrostomy, which was used for a 40-year-old female experiencing refractory post-pancreatectomy high-output EPF. We present a standardized management protocol for this procedure, which includes preoperative clinical and radiologic diagnosis of disconnected pancreatic duct syndrome and persistent EPF, detailed surgical steps with technical tips accompanied by a video demonstration, and perioperative care to facilitate postoperative recovery. The patient's postoperative course was uneventful. This technique simplifies a challenging and complex procedure, making it reproducible and teachable.

This novel technique provides a minimally invasive surgical solution for refractory EPF. Our experience shows that stent-bridging fistulogastrostomy is simple, safe, and effective. Further prospective studies are warranted to validate its long-term outcomes.