Duodenal fistula after gastrectomy: Retrospective study of 13 new cases

Abstract

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.

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

“…Thirty-seven out of which were excluded as not relevant, while 184 full-text articles were assessed for eligibility. After removing full-text articles not complying with inclusion criteria, 20 articles were included into qualitative synthesis [2–7, 9–22]. No item was included on the basis of other sources (eg.…”

“…General characteristics of the analyzed populations are shown by Table 1. Twenty included articles covered an approximately 40 years-study period (1979–2017), with a total 294 patient population [2–7, 9–22]. DSF diagnosis occurred between the fifth and tenth postoperative day (median days) [2–7, 9–22].…”

Laparoscopic reinforcement suture on staple-line of duodenal stump using barbed suture during laparoscopic gastrectomy for gastric cancer

“…Factors associated with DSF can be divided into patient factors and surgeon factors. Patient factors include age, comorbidity, nutritional status, existence of chronic ulcer or ectopic pancreas at duodenal bulb, cancer invasion to pylorus, gastric outlet obstruction and previous abdominal surgery, and so on [ 3 4 5 ]. Surgeon factors could be related to several surgical techniques, such as excessive vascular or pancreatic dissection around duodenal stump, direct thermal injury by ultrasonic shears and reinforcement suture [ 5 14 ].…”

“…The overall incidence of duodenal stump fistula (DSF) or duodenal stump leakage is reportedly between 1.6% to 5% and is one of the most serious complications of BillrothII or Roux en Y reconstruction after gastrectomy for gastric cancer [ 1 2 ]. Several investigators presented their clinical experience, such as the clinical course and the pertinent management of DSF [ 3 4 ]. Conservative approach for DSF is the treatment of choice, eventually associated with percutaneous drainage [ 4 ].…”

Prevalence of and Risk Factors for Abdominal Bleeding in Patients with External Duodenal Fistula

“…External duodenal fistula is a complication of gastric and kidney surgeries, pancreatitis, and inflammatory bowel disease (IBD). The reported overall morbidity and mortality related to duodenal fistula ranged from 38% to 75% and 7% to 40%, respectively [1,2].…”