Digestive Decompression to Prevent Digestive Fistulas After Gastric Neoplasm Resection

Marincaş, Augustin Marian; Prunoiu, Virgiliu-Mihail; Cirimbei, C; Buzatu, Raluca; Corniciuc, Rodica; Sersea, Cristian; Brătucu, E

doi:10.21614/chirurgia.111.5.400

Cited by 8 publications

(8 citation statements)

References 4 publications

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“…DSF pathogenesis remains unknown [2]. Main risk factors may be devascularization of duodenal stump or its inadequate surgical closure, inflammation of duodenal wall, local hematoma, neoplastic involvement of resection line, incorrect abdominal drain placement, and postoperative distension of the duodenum due to distal obstruction [2, 23].…”

Section: Discussionmentioning

confidence: 99%

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Management of duodenal stump fistula after gastrectomy for malignant disease: a systematic review of the literature

Zizzo

Ugoletti²,

Manzini³

et al. 2019

BMC Surg

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Background Duodenal stump fistula (DSF) remains one of the most serious complications following subtotal or total gastrectomy, as it endangers patient’s life. DSF is related to high mortality (16–20%) and morbidity (75%) rates. DSF-related morbidity always leads to longer hospitalization times due to medical and surgical complications such as wound infections, intra-abdominal abscesses, intra-abdominal bleeding, acute pancreatitis, acute cholecystitis, severe malnutrition, fluids and electrolytes disorders, diffuse peritonitis, and pneumonia. Our systematic review aimed at improving our understanding of such surgical complication, focusing on nonsurgical and surgical DSF management in patients undergoing gastric resection for gastric cancer. Methods We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. PubMed/MEDLINE, EMBASE, Scopus, Cochrane Library and Web of Science databases were used to search all related literature. Results The 20 included articles covered an approximately 40 years-study period (1979–2017), with a total 294 patient population. DSF diagnosis occurred between the fifth and tenth postoperative day. Main DSF-related complications were sepsis, abdominal abscess, wound infection, pneumonia, and intra-abdominal bleeding. DSF treatment was divided into four categories: conservative (101 cases), endoscopic (4 cases), percutaneous (82 cases), and surgical (157 cases). Length of hospitalization was 21–39 days, ranging from 1 to 1035 days. Healing time was 19–63 days, ranging from 1 to 1035 days. DSF-related mortality rate recorded 18.7%. Conclusions DSF is a rare but potentially lethal complication after gastrectomy for gastric cancer. Early DSF diagnosis is crucial in reducing DSF-related morbidity and mortality. Conservative and/or endoscopic/percutaneous treatments is/are the first choice. However, if the patient clinical condition worsens, surgery becomes mandatory and duodenostomy appears to be the most effective surgical procedure.

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Section: Discussionmentioning

confidence: 99%

“…For subtotal gastrectomy, Marincas et al recently suggested the use of an intraoperatively introduced duodenal decompression probe, with the aim of reducing DSF risk [23]. However, the results were unsatisfactory [23].…”

Section: Discussionmentioning

confidence: 99%

Management of duodenal stump fistula after gastrectomy for malignant disease: a systematic review of the literature

Zizzo

Ugoletti²,

Manzini³

et al. 2019

BMC Surg

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“…The surgical stress determines, apart from the metabolic and endocrine reactions, also ample immune reactions. The excess of lipid and protein catabolism, the diminution of the anabolic effect of insulin and the insulin resistance, all on the one side and the inflammatory reaction, with the increase in the levels of Il-6, I-l1, TNF, and C reactive protein, on the other side, can require a lot from the resources of the cancer patient (2). Both the surgical intervention and the anaesthesia can alter the mechanisms of defence and depress the essential natural killer cells and also decrease their activity in the destruction of cancer cells (12).…”

Section: Discussionmentioning

confidence: 99%

“…All these, next to the correct execution of the manual suture, or of the mechanical one, contribute to the avoidance of the appearance of fistulas. The implementation of the measures of protection of the anastomoses (such as the installation of the duodenal decompression tube in patients with palliative limited gastric resections and with gastrojejunal anastomosis, of the gastric aspiration tube when the gastric stump is kept, and the use of the oesophageal tube in total gastrectomy), have the role to diminish the pressure in the area of the anastomoses in the immediate postoperative period (2).…”

Section: Introductionmentioning

confidence: 99%

The Importance of the Nutritional Factor and the Stage of the Disease in Postoperative Fistula in Patients with Gastric Cancer

Prunoiu¹,

Marincaş²,

Pantiş³

et al. 2019

chr

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RezumatIntroducere: În cancerul gastric sunt factori generali şi locali multipli care pot determina fistulelor postoperatorii. În studiul de faţă am propus analiza rolului stării nutriţionale preoperatorii şi al terapiei nutriţionale împreună cu stadiul bolii, vârsta şi sexul pacienţilor în cazul apariţiei fistulelor. Material şi Metodă: Acest studiu retrospectiv a inclus 158 de pacienţi operaţi pentru cancer gastric în Clinica de Chirurgie în perioada 2010-2016, în care am analizat incidenţa fistulei anastomotice. Rezultate: Incidenţa globală a fistulelor a fost de 11%. Dintre cei 30 de pacienţi cu pierdere în greutate şi nutriţie parenterală pre şi post-parenterală parenterală, fistula a apărut la 13%, dintre 36 pacienţi cu pierdere în greutate şi nutriţie parenterală numai postoperator, 14%, din 24 de pacienţi cu pierdere în greutate şi fără terapie nutriţională, au făcut fistulă 21%, iar 68 de pacienţi fără pierdere în greutate au făcut fistulă numai 6%. Concluzie: În concluzie, incidenţa fistulei postoperatorie a fost mai mare în stadiile avansate de boală (p=0.027) precum şi la pacienţii cu vârsta de peste 70 de ani. Putem spune că terapia nutriţională a condus la scăderea numărului de fistule (p=0.047) Cuvinte cheie: cancer gastric, nutritie, oncologie geriatrică Abstract Introduction: In gastric cancer there are multiple local and general risk factors for the occurrence of postoperative fistulas. In the present study, we proposed to analyse the role of the preoperative nutritional state and nutritional therapy along with the disease stage, the age and the sex of patients in the occurrence of fistulas. Material and method: This retrospective study included 158 patients operated for gastric cancer in Surgery Department of Bucharest Oncology institute between January 2010 and December 2016 in which we analysed the incidence of anastomotic fistula according to the nutritional status, disease status, age and sex of the patients. Results: The global incidence of fistulas was of 11%, out of which 8 % were fistulas of the duodenal stump and 3.19% fistulas of the eso-jejunal anastomosis. Out of the 30 patients with weight loss and parenteral nutrition in the preop period, we had 4 fistulas (13%), and out of the 36 patients with weight loss and nutritional measures in the postop we had 5 fistulas (14%), also, out of the 24 patients with weight loss and without nutritional intervention, we had 5 fistulas (21%), finally, out of the 68 patients without weight loss we had fistulas in 4 patients (6%).. The incidence of fistulas was 5% in patients with stage I, II and III and 24% in stage IV patients. The distribution of fistulas according to the age of the patients showed a much higher incidence of fistulae in patients over 70 years old. Conclusions: − The number of postoperative fistulas was higher in the advanced stages of the disease (p=0.027) and in patients over 70 years old (p=0.047) and the differences were statistically significant. − The difference between the number of fistulae occurred in patients who had wei...

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“…However, edema of the stomach and malnutrition lower the function of immune system, which increases the risk of perioperative complications ( 2 ). To avoid complications such as infection, anastomotic leakage, and preoperative decompression of the stomach, nutrition therapy is necessary in these patients ( 5 ).…”

Section: Introductionmentioning

confidence: 99%

Effect of preoperative nutrition therapy type and duration on short-time outcomes in gastric cancer patient with gastric outlet obstruction

et al. 2021

Chinese Journal of Cancer Research

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Objective To avoid perioperative complications caused malnutrition, nutrition therapy is necessary in gastric outlet obstruction (GOO) patients. Compared to parenteral nutrition (PN), enteral nutrition (EN) is associated with many advantages. This study aimed to investigate whether preoperative EN has beneficial clinical effects compared to preoperative PN in gastric cancer patients with GOO undergoing surgery. Methods According to the methods of preoperative nutrition therapy, 143 patients were divided into EN group (n=42) and PN group (n=101) between January 2013 and December 2017 at the Chinese People’s Liberation Army General Hospital. Multiple logistic regression models were used to assess the association between the methods of preoperative nutrition therapy and postoperative day of flatus passage. The generalized additive model and two-piecewise linear regression model were used to calculate the inflection point of the preoperative nutritional therapy time on the postoperative day of flatus passage in the PN group. Results EN shortened the postoperative day of flatus passage in gastric cancer patients with GOO, which is a protective factor, especially in patients who underwent non-radical operations and the postoperative day of flatus passage reduced when the preoperative PN therapy was up to 3 d and a longer PN therapy (>3 d) did not accelerate the postoperative recovery of gastrointestinal functions. Conclusions Preoperative EN therapy would benefit gastric cancer patients with GOO by accelerating postoperative recovery. For patients with absolute obstruction, no more than 3-day PN therapy is recommended if patients can tolerate general anesthesia and surgery.

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Digestive Decompression to Prevent Digestive Fistulas After Gastric Neoplasm Resection

Cited by 8 publications

References 4 publications

Management of duodenal stump fistula after gastrectomy for malignant disease: a systematic review of the literature

Management of duodenal stump fistula after gastrectomy for malignant disease: a systematic review of the literature

The Importance of the Nutritional Factor and the Stage of the Disease in Postoperative Fistula in Patients with Gastric Cancer

Effect of preoperative nutrition therapy type and duration on short-time outcomes in gastric cancer patient with gastric outlet obstruction

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