Outcomes of Non-Operative Treatment for Duodenal Stump Leakage after Gastrectomy in Patients with Gastric Cancer

Abstract

PurposeWe evaluated the clinical outcomes of the non-operative management of post-gastrectomy duodenal stump leakage in patients with gastric cancer.Materials and MethodsA total of 1,230 patients underwent gastrectomy at our institution between 2010 and 2014. Duodenal stump leakage was diagnosed in 19 patients (1.5%), and these patients were included in this study. The management options varied with patient condition; patients were managed conservatively, with a pigtail catheter drain, or by tube duodenostomy via a Foley catheter. The patients' clinical outcomes were analyzed.ResultsDuodenal stump leakage was diagnosed in all 19 patients within a median of 10 days (range, 1~20 days). The conservative group comprised of 5 patients (26.3%), the pigtail catheter group of 11 patients (57.9%), and the Foley catheter group of 3 patients (15.8%). All 3 management modalities were successful; none of the patients needed further operative intervention. The median hospital stay was 18, 33, and 42 days, respectively.ConclusionsNon-operative management of duodenal stump leakage for selected groups of patients with gastric cancer was effective for control of intra-abdominal sepsis. This management modality can help obviate the need for surgical intervention.

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

“…Kostakis et al, based on a systematic review, reported the highest postoperative DSL frequency [10]. Compared to other reports including laparotomy cases [7,8,[12][13][14], the DSL incidence rates in this study were low, at slightly less than 6.0% if the duodenal stump was not reinforced, and remarkably low at just 0.67% when reinforced. Since our institution is a high-volume center in Japan with a large number of cases, such social factors may have influenced surgical outcomes.…”

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].…”

“…DSF is related to high mortality (16–20%) and morbidity (75%) rates, as a recent Italian multicenter study corfirmed [2]. Moreover, 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 [6, 7].…”

Laparoscopic Reinforcement Suture (LARS) on Staple Line of Duodenal Stump Using Barbed Suture in Laparoscopic Gastrectomy for Gastric Cancer: a Prospective Single Arm Phase II Study

“…Among these approaches, the lowest leakage rate was achieved after reinforcement on the staple line using absorbable membrane or oversewing the suture line [ 27 ]. Based on a systematic review and a large retrospective study [ 8 28 ], conservative treatment for duodenal stump leakage was determined to be the treatment of choice, eventually associated with percutaneous drainage or percutaneous transhepatic biliary drainage (PTBD) [ 29 ]. Re-exploration is recommended in severe cases or for patients who do not respond to conservative treatment.…”