A Life‐saving but Inadequately Discussed Procedure: Tube Duodenostomy. Known and Unknown Aspects

Işık, Burak; Yılmaz, Sezai; Kırımlıoğlu, Vedat; Söğütlü, Gökhan; Yılmaz, Mehmet; Katz, Daniel

doi:10.1007/s00268-007-9114-3

Cited by 43 publications

(47 citation statements)

References 58 publications

(93 reference statements)

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“…Our result shows that a safe closure of duodenal stump is possible in most cases with GOO by advanced carcinoma of the distal stomach. The first portion of the duodenum measures 4-5 cm, which is sufficient to allow resection of 3-4 cm of the duodenum beyond the pylorus with a safe closure of duodenal stump [33].…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of gastric outlet obstruction on the oncologic and surgical outcomes of radical surgery for carcinoma of the distal stomach

Park

Mok

Kim

et al. 2009

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 99%

Clinical significance of gastric outlet obstruction on the oncologic and surgical outcomes of radical surgery for carcinoma of the distal stomach

Park

Mok

Kim

et al. 2009

Journal of Surgical Oncology

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“…In the years, different strategies have been proposed for DSF treatment: from surgical procedures (such as tube duodenostomy [3,4], repair with a rectus abdominis muscle flap [5], closure by a Roux-en-Y duodenojejunostomy [6,7] or pancreatoduodenectomy [8] ) to percutaneous approach, (such as abscess drainage, transhepatic biliary drainage [9,10], fistuloscopy [11] and fistula obliteration by cyanoacrylate or prolamine [12], or, more recently, percutaneous transhepatic biliary drainage and occlusion balloon [13]). …”

Section: Introductionmentioning

confidence: 99%

Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience

et al. 2014

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Background Duodenal stump fistula (DSF) is the most severe surgical complication after gastrectomy. This study was designed to assess the incidence, to observe the consequences, and to identify the risk factors associated with DSF after gastrectomy. Methods All procedures involving total or sub-total gastrectomy for cancer, performed between January 1987 and June 2012 in a single institution, were prospectively entered into a computerized database. Risk factors analysis was performed between DSF patients, patients with complete uneventful postoperative course and patients with other major surgical complications. Results Over this 25 years period, 1287 gastrectomies were performed. DSF was present in 32 cases (2.5 %). Mean post-operative onset was 6.6 days. 19 patients were treated conservatively and 13 surgically. Mean DSF healing time was 31.2 and 45.2 days in the two groups, respectively. Mortality was registered in 3 cases (9.37 %), due to septic shock (2 cases) and bleeding (1 case). In monovariate analysis, heart disease (p \ 0.001), pre-operative lymphocytes number (p = 0.003) and absence of manual reinforcement over duodenal stump (p \ 0.001) were found to be DSF-specific risk factors, whereas liver cirrhosis (p = 0.002), pre-operative albumin levels (p \ 0.001) and blood losses (p = 0.002) were found to be non-DSF-specific risk factors. In multivariate analysis heart disease (OR 5.18; p \ 0.001), liver cirrhosis (OR 13.2; p \ 0.001), bio-humoral nutritional status impairment (OR 2.29; p = 0.05), blood losses [300 mL (OR 4.47; p = 0.001) and absence of manual reinforcement over duodenal stump (OR 30.47; p \ 0.001) were found to be independent risk factors for DSF development. Conclusions Duodenal stump fistula still remains a lifethreatening complication after gastric surgery. Co-morbidity factors, nutritional status impairment and surgical technical difficulties should be considered as important risk factors in developing this awful complication.

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“…Focusing now on the long term treatment of DSF, different surgical approaches have been proposed, such as duodenostomy (20), reparation with rectus abdominal muscle flap (21), closure with a duodenojejunostomy in Rouxen-Y (22) or performing a pancreaticoduodenectomy (23).…”

Section: Discussionmentioning

confidence: 99%

Duodenal fistula after gastrectomy: Retrospective study of 13 new cases

Cornejo¹,

Priego²,

Ramos³

et al. 2015

Rev Esp Enferm Dig

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Introduction: Duodenal stump fistula (DSF) after gastrectomy has a low incidence but a high morbidity and mortality, and is therefore one of the most aggressive and feared complications of this procedure. Material and methods:We retrospectively evaluated all DSF occurred at our hospital after carrying out a gastrectomy for gastric cancer, between January 1997 and December 2014. We analyzed demographic, oncologic, and surgical variables, and the evolution in terms of morbidity, mortality and hospital stay.Results: In the period covered in this study, we performed 666 gastrectomies and observed DSF in 13 patients (1.95%). In 8 of the 13 patients (61.5%) surgery was the treatment of choice and in 5 cases (38.5%) conservative treatment was carried out.Postoperative mortality associated with DSF was 46.2% (6 cases). In the surgical group, 3 patients developed severe sepsis with multiple organ failure, 2 patients presented a major hematemesis which required endoscopic haemostasis, 1 patient had an evisceration and another presented a subphrenic abscess requiring percutaneous drainage. Six patients (75%) died despite surgery, with 3 deaths in the first 24 hours of postoperative care. The 2 patients who survived after the second surgical procedure had a hospital stay of 45 and 84 days respectively. In the conservative treatment group the cure rate was 100% with no significant complications and an average postoperative hospital stay of 39.5 days (range, 26-65 days).Conclusion: FMD is an unusual complication but it is associated with a high morbidity and mortality. In our experience, conservative management has shown better results compared with surgical treatment.

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A Life‐saving but Inadequately Discussed Procedure: Tube Duodenostomy. Known and Unknown Aspects

Abstract: We conclude that tube duodenostomy is a simple, effective, and safe method to prevent rupture of an insecure duodenal stump or to treat the leakage from the duodenal stump or primary repair on the duodenum.

Cited by 43 publications

References 58 publications

Clinical significance of gastric outlet obstruction on the oncologic and surgical outcomes of radical surgery for carcinoma of the distal stomach

Clinical significance of gastric outlet obstruction on the oncologic and surgical outcomes of radical surgery for carcinoma of the distal stomach

Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience

Duodenal fistula after gastrectomy: Retrospective study of 13 new cases

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