NEW ADVANCES IN THE TREATMENT OF CHRONIC PANCREATIC FISTULAS

Abstract. Introduction. External post-necrotic pancreatic fistulas can persist for months, worsening the quality of the patient’s life. Conservative and minimally invasive treatment methods are priorities for this pathology, with the primary focus on diagnosing and correcting intraductal hypertension. Aim. To present clinical observations on the minimally invasive elimination of external pancreatic fistulas resulting from necrotizing pancreatitis. Materials and Methods. We analyzed cases of 6 patients over 3 years with necrotic forms of acute pancreatitis that developed complications, such as persistent external pancreatic fistulas. After having verified the fistula and corrected intraductal hypertension, we performed sclerotherapy on these external fistulas. This article also describes the first one of these clinical cases. Results and Discussions. In all six cases, we observed the rapid closure of chronic post-necrotic pancreatic fistulas and maintenance of the achieved effect over more than a year of follow-up. Conclusions. Experience of Russian and foreign surgery colleagues shows the priority of using minimally invasive techniques in treating most complications of necrotizing pancreatitis, particularly external pancreatic fistulas. Extensive surgical interventions in such patients generally carry high risks. We were the first to apply sclerotherapy using aethoxysklerol for this complication; the successful experience suggests its further application, alone or in combination with other minimally invasive techniques.