Duodenal stump fistula after gastrectomy for gastric cancer: risk factors, prevention, and management

Paik, Hyun-June; Lee, Si Hak; Choi, Chang In; Kim, Dae Hwan; Jeon, Tae Yong; Kim, Dong Heon; Jeon, Ung Bae; Choi, Cheol Woong; Hwang, Sun-Hwi

doi:10.4174/astr.2016.90.3.157

Cited by 33 publications

(36 citation statements)

References 18 publications

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“…DSL has several causes, as noted above. Paik et al reported that gastric outlet obstruction before surgery was a significant risk factor for DSL due to inflammation of the surrounding duodenal wall tissue [9]. In addition, the staple line itself in patients requiring re-operation was actually intact in our study.…”

Section: Discussionsupporting

confidence: 55%

Duodenal stump reinforcement might reduce both incidence and severity of duodenal stump leakage after laparoscopic gastrectomy with Roux-en-Y reconstruction for gastric cancer

Hiki

Ishizuka

et al. 2019

Gastric Cancer

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Background Although duodenal stump leakage (DSL) is a relatively rare complication after gastrectomy with Roux-en-Y (R-Y) reconstruction, it is difficult to treat and can be fatal. We investigated the impact of duodenal stump reinforcement on DSL after laparoscopic gastrectomy with R-Y reconstruction for gastric cancer. Methods This retrospective study of 965 patients with gastric cancer who underwent laparoscopic distal or total gastrectomy (LDG or LTG) with R-Y reconstruction compared surgical outcomes between two groups, the duodenal stump reinforcement group (reinforcement group) (n = 895) and that without duodenal stump reinforcement (non-reinforcement group) (n = 70). Results Mean operative duration was significantly longer in the reinforcement than in the non-reinforcement group (LDG; 291 min versus 258 min, p < 0.001, LTG; 325 min versus 285 min, p < 0.001). DSL occurred less frequently in the reinforcement than in the non-reinforcement group (0.67% vs. 5.71%, p < 0.001). Furthermore, non-reinforcement was an independent risk factor for DSL in multiple logistic regression analysis with adjustment for potential confounding factors. Patients with DSL in the non-reinforcement group all required re-operation, while all but one patient with DSL in the reinforcement group recovered with conservative management. Conclusions Duodenal stump reinforcement in laparoscopic gastrectomy with R-Y reconstruction may reduce the risk of DSL development and minimize its severity.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Section: Discussionsupporting

confidence: 55%

Duodenal stump reinforcement might reduce both incidence and severity of duodenal stump leakage after laparoscopic gastrectomy with Roux-en-Y reconstruction for gastric cancer

Hiki

Ishizuka

et al. 2019

Gastric Cancer

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“…Our study highlighted 114 cases of early complications after radical gastrectomy ( concluded that preoperative multiple comorbidity was the main reason of postoperative duodenal stump stula. 17 ; 3. In the past, the stump was only reinforced, but not embedded.…”

Section: Discussionmentioning

confidence: 99%

Modified Clavien-Dindo Classification to Analyze the Risk Factors of Early Complications after Radical Gastrectomy and the Impact of Complications on Long-Term Prognosis

Ma¹,

Wang²,

Yu³

et al. 2020

Preprint

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Background The modified Clavien-Dindo classification system was employed to investigate the occurrence of early complications along with the related risk factors following a radical gastrectomy procedure, with the view of conducting an analysis into the impact of complications on long-term prognosis. Methods The clinical data of 525 patients who had previously undergone a radical gastrectomy procedure for gastric cancer were analyzed in a retrospective fashion. Results Postoperative hospital stay: Complication group (17.88±8.472) days, severe complications group (23.10±7.594) days, significantly higher than non-complication group (10.26±1.973) days and non-severe complications group (11.47±4.712) days (P=0.000<0.05).Multivariate analysis: age (OR = 1.781, P = 0.013), preoperative comorbidity (OR = 1.765, P = 0.020), blood loss (OR = 2.153, P = 0.001), surgical approach (OR = 3.137, P = 0.000) were identified as an independent risk factor associated with early complications. Blood loss (OR=13.053, P=0.013), type of resection (OR=7.936, P=0.047) and nerve involvement (OR=3.670, P=0.009) were identified to be independent risk factors for severe complications.Severe postoperative complications (HR=1.595, P=0.107) and postoperative complications (HR=1.078, P=0.670) were not independent risk factors affecting the 5-year over survival rate. Conclusion Complications following radical gastrectomy were closely related to age, preoperative comorbidity, blood loss, and surgical approach; severe complications were closely related to blood loss, total gastrectomy, and nerve involvement; complications and severe complications were not found to be independent risk factors associated with long-term survival, that being said, they were significantly prolonged postoperative hospital stay.

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“…Some surgeons applied fibrinsealant (Greenplasty, Green Cross Corp., Seoul, Korea) or absorbable reinforcement felt (Neoveil, Gunze Ltd., Kyoto, Japan) at staple-line of duodenal stump to prevent the DSF. However, its clinical efficacy remains unclear [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…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 ].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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PurposeDuodenal stump fistula (DSF) is a serious complication after gastrectomy for gastric cancer. Although risk evaluation and management of DSF were presented by some investigators, there was no technical attempt has been made to prevent DSF during laparoscopic gastrectomy until now.MethodsConsecutive 99 patients were enrolled from April 2014 to February 2016 in 2 institutes. All patients were performed laparoscopic gastrectomy for gastric cancer. After cutting of duodenal stump, laparoscopic reinforcement suture (LARS) commenced with continuous invagination method or interrupted method by barbed suture. Clinicopathologic features and postoperative outcomes were analyzed.ResultsFifty-six patients had comorbidity including 5 patients with duodenal ulcer. Most patients were performed distal gastrectomy with B-II, and 10 patients total gastrectomy with Roux en Y esophagojejunostomy. Although there were 2 esophagojejunostomy leakage and 1 artificial lesser curvature leakage, DSF did not occurred at all in this study. Mean operation time was 3 hours and mean LARS procedure time was 8 minutes.ConclusionLARS of duodenal stump can be considered as one of prevention methods of DSF during laparoscopic gastrectomy for gastric cancer. So this new technique will be necessary to appropriately evaluate by prospective randomized controlled trial in the future.

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Duodenal stump fistula after gastrectomy for gastric cancer: risk factors, prevention, and management

Cited by 33 publications

References 18 publications

Duodenal stump reinforcement might reduce both incidence and severity of duodenal stump leakage after laparoscopic gastrectomy with Roux-en-Y reconstruction for gastric cancer

Duodenal stump reinforcement might reduce both incidence and severity of duodenal stump leakage after laparoscopic gastrectomy with Roux-en-Y reconstruction for gastric cancer

Modified Clavien-Dindo Classification to Analyze the Risk Factors of Early Complications after Radical Gastrectomy and the Impact of Complications on Long-Term Prognosis

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

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