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Rott G, Boecker F, Schimmack S. Duodenal stump fistula managed with percutaneous drainage, percutaneous transcholecystic biliary diversion and transduodenal glue embolization - A case report. Radiol Case Rep 2024; 19:1930-1934. [PMID: 38449489 PMCID: PMC10915783 DOI: 10.1016/j.radcr.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/04/2024] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
Duodenal stump insufficiency is an infrequent but potentially devastating complication of upper gastrointestinal surgery. In the era of image-guided interventions, duodenal stump insufficiency is usually treated rather conservatively or with percutaneous interventions than with surgery. Herein, we present a case of a postsurgical duodenal stump fistula successfully treated in a step-by-step manner with percutaneous drainage of a periduodenal abscess-fistula complex, percutaneous transcholecystic biliary drainage for partial biliary diversion and percutaneous transcatheter fistula embolization via the duodenum with n-butyl-cyanoacrylate.
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Affiliation(s)
- Gernot Rott
- Department of Radiology, Bethesda-Hospital, Duisburg, Germany
| | - Frieder Boecker
- Institute of Clinical Radiology, Lukas-Hospital, Neuss, Germany
| | - Simon Schimmack
- Department of General, Visceral and Endocrine Surgery, Bethesda-Hospital, Duisburg, Germany
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Naito R, Nakazawa N, Zennyoji D, Shimizu T, Hosoi N, Watanabe T, Shioi I, Shibasaki Y, Osone K, Okada T, Shiraishi T, Sano A, Sakai M, Ogawa H, Sohda M, Uraoka T, Shirabe K, Saeki H. Retrograde drainage for duodenal stump leakage using ileal decompression tube guided by double-balloon endoscopy: a novel case report. Surg Case Rep 2024; 10:44. [PMID: 38368309 PMCID: PMC10874345 DOI: 10.1186/s40792-024-01842-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/08/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Duodenal stump leakage is a serious post-gastrectomy complication, and there have been no reports on endoscopic drainage. CASE PRESENTATION We report a case of duodenal stump leakage after laparoscopic gastrectomy with Roux-en-Y reconstruction in a 68-year-old man. First-line conservative management was ineffective. Reoperation was performed because of severe abdominal pain and increased ascites. After reoperation, duodenal stump leakage recurred with bleeding from the anterior superior pancreaticoduodenal artery. Coil embolization and pigtail catheter insertion were performed. Furthermore, we retrogradely inserted an ileal tube for tube decompression near the duodenal stump using double-balloon endoscopy for effective drainage. After tube insertion, duodenal stump leakage decreased; on the 47th primary postoperative day, the patient was discharged. The primary postoperative course was uneventful after 1 year and 9 months of follow-up. CONCLUSIONS This is the first successful case of duodenal stump leakage treated with retrograde decompression tube insertion near the duodenal stump using double-balloon endoscopy.
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Affiliation(s)
- Ryozan Naito
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-15, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Nobuhiro Nakazawa
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-15, Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
| | - Dan Zennyoji
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takehiro Shimizu
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Nobuhiro Hosoi
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-15, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Takayoshi Watanabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-15, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Ikuma Shioi
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-15, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Yuta Shibasaki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-15, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Katsuya Osone
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-15, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Takuhisa Okada
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-15, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Takuya Shiraishi
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-15, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Akihiko Sano
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-15, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Makoto Sakai
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-15, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiroomi Ogawa
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-15, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Makoto Sohda
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-15, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Toshio Uraoka
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-15, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Hiroshi Saeki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-15, Showa-Machi, Maebashi, Gunma, 371-8511, Japan
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Wang XT, Ya HQ, Wang L, Chen HH, Zhang YF, Luo XH, Li L, Kong FB, Zhong XG, Mai W. Trocar puncture with modified sump drainage for duodenal stump fistula after radical gastrectomy for gastric cancer: A retrospective controlled study. Surg Open Sci 2023; 16:121-126. [PMID: 37876666 PMCID: PMC10590734 DOI: 10.1016/j.sopen.2023.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/10/2023] [Accepted: 09/17/2023] [Indexed: 10/26/2023] Open
Abstract
Duodenal stump fistula (DSF) is a serious complication of radical gastrectomy for gastric cancer. Herein, we illustrated an innovative choice for treating duodenal stump fistulas by placing a modified sump drainage through trocar puncture into the DSF-related abscess (DSF-abscess) cavity. We retrospectively analyzed 974 consecutive patients who underwent gastrectomy for gastric cancer between 2011 and 2021. Of these patients, 34 who developed postoperative duodenal stump fistulas postoperatively were enrolled into our study, and their clinical data were retrospectively assessed. From January 2011 to December 2017, 15 patients received conventional treatments (percutaneous catheter drainage, PCD group) known as the traditional percutaneous method, and 19 patients from January 2018 to December 2021 received new treatments (Troca's SD group) consisting of conventional therapies and placement of a modified sump drainage through trocar puncture into DSF-abscess cavity. The demographics, clinical characteristics and treatment outcomes were compared between two groups. Compared with the PCD group, the rates of postoperative complications, duodenostomy creation, subsequent surgery, fistula healing rates of the DSF, and length of postoperative hospital stay were significantly decreased in the Troca SD group. However, there was no significant difference in the abscess recurrence rate and mortality rates. Trocar puncture with a modified sump drainage is an safe, effective, and technically feasible treatment for duodenal stump fistula after radical gastrectomy for gastric cancer. This novel technique should be further investigated using large-scale RCT research.
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Affiliation(s)
- Xiao-Tong Wang
- Departments of Gastrointestinal, Hernia and Enterofistula Surgery, People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Minimally Invasive Technology and Applications, Guangxi Academy of Medical Sciences, Nanning 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Han-Qing Ya
- Departments of Gastrointestinal, Hernia and Enterofistula Surgery, People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Minimally Invasive Technology and Applications, Guangxi Academy of Medical Sciences, Nanning 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Long Wang
- Departments of Gastrointestinal, Hernia and Enterofistula Surgery, People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Minimally Invasive Technology and Applications, Guangxi Academy of Medical Sciences, Nanning 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Huan-Huan Chen
- Departments of Colorectum and Anus Surgery, People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Minimally Invasive Technology and Applications, Guangxi Academy of Medical Sciences, Nanning 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Yan-Fei Zhang
- Departments of Gastrointestinal, Hernia and Enterofistula Surgery, People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Minimally Invasive Technology and Applications, Guangxi Academy of Medical Sciences, Nanning 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Xiao-Hong Luo
- Departments of Gastrointestinal, Hernia and Enterofistula Surgery, People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Minimally Invasive Technology and Applications, Guangxi Academy of Medical Sciences, Nanning 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Lei Li
- Departments of Gastrointestinal, Hernia and Enterofistula Surgery, People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Minimally Invasive Technology and Applications, Guangxi Academy of Medical Sciences, Nanning 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Fan-Biao Kong
- Departments of Colorectum and Anus Surgery, People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Minimally Invasive Technology and Applications, Guangxi Academy of Medical Sciences, Nanning 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Xiao-Gang Zhong
- Departments of Gastrointestinal, Hernia and Enterofistula Surgery, People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Minimally Invasive Technology and Applications, Guangxi Academy of Medical Sciences, Nanning 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Wei Mai
- Departments of Gastrointestinal, Hernia and Enterofistula Surgery, People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Minimally Invasive Technology and Applications, Guangxi Academy of Medical Sciences, Nanning 530021, Guangxi Zhuang Autonomous Region, People's Republic of China
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Kim YI, Lee JY, Khalayleh H, Kim CG, Yoon HM, Kim SJ, Yang H, Ryu KW, Choi IJ, Kim YW. Efficacy of endoscopic management for anastomotic leakage after gastrectomy in patients with gastric cancer. Surg Endosc 2021; 36:2896-2905. [PMID: 34254185 PMCID: PMC9001531 DOI: 10.1007/s00464-021-08582-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/02/2021] [Indexed: 12/24/2022]
Abstract
Background Anastomotic leakage (AL) after gastrectomy in gastric cancer patients is associated with high mortality rates. Various endoscopic procedures are available to manage this postoperative complication. The aim of study was to evaluate the outcome of two endoscopic modalities, clippings and stents, for the treatment of AL. Patients and methods There were 4916 gastric cancer patients who underwent gastrectomy between December 2007 and January 2016 at the National Cancer Center, Korea. A total of 115 patients (2.3%) developed AL. Of these, 85 patients (1.7%) received endoscopic therapy for AL and were included in this retrospective study. The endpoints were the complete leakage closure rates and risk factors associated with failure of endoscopic therapy. Results Of the 85 patients, 62 received endoscopic clippings (with or without detachable snares), and 23 received a stent insertion. Overall, the complete leakage closure rate was 80%, and no significant difference was found between the clipping and stent groups (79.0% vs. 82.6%, respectively; P = 0.89). The complete leakage closure rate was significantly lower in the duodenal and jejunal stump sites (60%) than esophageal sites (86.1%) and gastric sites (94.1%; P = 0.026). The multivariate analysis showed that stump leakage sites (adjusted odds ratio [aOR], 4.51; P = 0.031) and the presence of intra-abdominal abscess (aOR, 4.92; P = -0.025) were associated with unsuccessful leakage closures. Conclusions Endoscopic therapy using clippings or stents is an effective method for the postoperative management of AL in gastric cancer patients. This therapy can be considered a primary treatment option due to its demonstrated efficacy, safety, and minimally invasive nature.
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Affiliation(s)
- Young-Il Kim
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea
| | - Jong Yeul Lee
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea.
| | - Harbi Khalayleh
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea.,The Department of Surgery, Faculty of Medicine, Kaplan Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Chan Gyoo Kim
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea
| | - Hong Man Yoon
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea
| | - Soo Jin Kim
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea
| | - Hannah Yang
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea.,Division of Biology and Biological Engineering, California Institute of Technology Pasadena, Pasadena, CA, 91125, USA
| | - Keun Won Ryu
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea
| | - Il Ju Choi
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea
| | - Young-Woo Kim
- Center for Gastric Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea. .,Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, 323 Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea.
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Po Chu Patricia Y, Ka Fai Kevin W, Fong Yee L, Kiu Jing F, Kylie S, Siu Kee L. Duodenal stump leakage. Lessons to learn from a large-scale 15-year cohort study. Am J Surg 2020; 220:976-981. [PMID: 32171473 DOI: 10.1016/j.amjsurg.2020.02.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/14/2020] [Accepted: 02/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Duodenal stump leakage is a challenging condition causing significant morbidity and mortality. The aim of this study is to identify the risk factors associated with duodenal leak and advocate modification to prevent the incident. METHODS A retrospective cohort study was performed to include patients who had gastrectomy with excluded duodenum in a single surgical centre in the period of Jan 2003-March 2017. Analysis of associated factors was performed. Patients with duodenal leak were further analyzed and the treatment strategy was reviewed. RESULTS During the study period, 678 patients had gastrectomy with excluded duodenum. 502 patients had elective gastrectomy and 176 patients had emergency gastrectomy. 52 patients had subsequent duodenal stump leakage (7.7%). The existence of duodenal ulcer, intra-operative contamination, lower pre-operative haemoglobin and duodenostomy were the independent associated factors for duodenal leak. CONCLUSION This is the largest cohort in studying associated factors regarding duodenal leak in both emergency and elective gastrectomy. The independent associated factors were identified. We advocate a conservative approach for duodenal leak with adequate drainage, nutrition and antibiotics.
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Affiliation(s)
| | | | - Lam Fong Yee
- Department of Surgery, Tuen Mun Hospital, Hong Kong, China
| | - Fung Kiu Jing
- Department of Surgery, Tuen Mun Hospital, Hong Kong, China
| | - Szeto Kylie
- Department of Surgery, Tuen Mun Hospital, Hong Kong, China
| | - Leung Siu Kee
- Department of Surgery, Tuen Mun Hospital, Hong Kong, China
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Kong X, Cao Y, Yang D, Zhang X. Continuous irrigation and suction with a triple-cavity drainage tube in combination with sequential somatostatin-somatotropin administration for the management of postoperative high-output enterocutaneous fistulas: Three case reports and literature review. Medicine (Baltimore) 2019; 98:e18010. [PMID: 31725672 PMCID: PMC6867794 DOI: 10.1097/md.0000000000018010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Enterocutaneous fistula is considered one of the most serious complications in general surgery and is associated with high morbidity and mortality. Although various treatments are reported to have varying success, high-output enterocutaneous fistulas (output over 500 ml/day) continue to be associated with high mortality, and few papers on this topic exist in the literature. The aim of this study is to describe an effective multidisciplinary treatment method for postoperative high-output enterocutaneous fistula and discuss the clinical development of the therapeutic strategy. PATIENT CONCERNS Three patients suffered high-output enterocutaneous fistulas, in which case 1 presented with duodenal fistula, case 2 with ileal fistula, and case 3 with small bowel fistula. DIAGNOSIS All 3 cases were diagnosed with high-output enterocutaneous fistulas by drainage of intestinal contents. INTERVENTIONS With the exception of routine treatment including fluid resuscitation, correction of the electrolyte balance, control of infection, and optimal nutrition, all the cases accepted continuous irrigation and suction with triple-cavity drainage tubes in combination with sequential somatostatin-somatotropin administration were given. With regard to establishing effective drainage, the triple-cavity tube placement was performed by insertion through the initial drainage channel in case 1, percutaneous puncture with dilation by graduated dilators in case 2, and tract reconstruction in case 3. The technical details of the approach are described and clinical characteristics including fistula location, defect size, output volume, approach of triple-cavity tube placement, length of fistula tract, somatostatin and somatotropin administration time, and fistula healing time were recorded and compared. In addition, other various techniques reported in the literature are reviewed and discussed. OUTCOMES All the patients were cured by the multidisciplinary treatments and were followed up without fistula recurrence and other relevant complications at 1 week, 1 month, and 3 months after the treatments. CONCLUSION The strategy involving continuous irrigation and suction with a triple-cavity drainage tube in combination with sequential somatostatin-somatotropin administration may be a safe and effective alternative treatment for postoperative high-output enterocutaneous fistula and a more practical method that is easy to execute to manage this problem. Long-term studies, involving more patients, are still necessary to confirm this suggestion.
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Affiliation(s)
| | - Yuning Cao
- Department of Digestion, Liaocheng People's Hospital, Liaocheng, Shandong Provence
| | | | - Xiangyang Zhang
- Department of General Surgery, Wanshan Branch of Xiangyang Central Hospital, Xiangyang, Hubei Provence, China
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Zizzo M, Ugoletti L, Manzini L, Castro Ruiz C, Nita GE, Zanelli M, De Marco L, Besutti G, Scalzone R, Sassatelli R, Annessi V, Manenti A, Pedrazzoli C. Management of duodenal stump fistula after gastrectomy for malignant disease: a systematic review of the literature. BMC Surg 2019; 19:55. [PMID: 31138190 PMCID: PMC6540539 DOI: 10.1186/s12893-019-0520-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/21/2019] [Indexed: 02/07/2023] Open
Abstract
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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Affiliation(s)
- Maurizio Zizzo
- Department of Oncology and Advanced Technologies, Surgical Oncology Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, AUSL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy. .,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
| | - Lara Ugoletti
- General and Emergency Surgery Unit, Ospedale Civile di Guastalla, AUSL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Lorenzo Manzini
- Department of Oncology and Advanced Technologies, Surgical Oncology Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, AUSL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Carolina Castro Ruiz
- General and Emergency Surgery Unit, Ospedale Civile di Guastalla, AUSL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Gabriela Elisa Nita
- Department of Oncology and Advanced Technologies, Surgical Oncology Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, AUSL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Magda Zanelli
- Department of Oncology and Advanced Technologies, Pathology Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, AUSL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Loredana De Marco
- Department of Oncology and Advanced Technologies, Pathology Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, AUSL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Giulia Besutti
- Department of Imaging and Laboratory Medicine, Radiology Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, AUSL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Rocco Scalzone
- Department of Oncology and Advanced Technologies, Surgical Oncology Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, AUSL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Romano Sassatelli
- Department of Oncology and Advanced Technologies, Gastrointestinal Endoscopy Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, AUSL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Valerio Annessi
- General and Emergency Surgery Unit, Ospedale Civile di Guastalla, AUSL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
| | - Antonio Manenti
- Department of General Surgery, Azienda Ospedaliero-Universitaria Policlinico, Del Pozzo Street 71, 41124, Modena, Italy
| | - Claudio Pedrazzoli
- Department of Oncology and Advanced Technologies, Surgical Oncology Unit, Arcispedale Santa Maria Nuova di Reggio Emilia, AUSL-IRCCS di Reggio Emilia, 42123, Reggio Emilia, Italy
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8
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Devaraj P, Gavini H. Endoscopic management of postoperative fistulas and leaks. GASTROINTESTINAL INTERVENTION 2017. [DOI: 10.18528/gii160032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Prathab Devaraj
- Department of Gastroenterology, Hepatology, and Nutrition, Banner University Medical Center, Tucson, AZ, USA
| | - Hemanth Gavini
- Department of Gastroenterology, Hepatology, and Nutrition, Banner University Medical Center, Tucson, AZ, USA
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9
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Cornejo MDLÁ, Priego P, Ramos D, Coll M, Ballestero A, Galindo J, García-Moreno F, Rodríguez G, Carda P, Lobo E. Duodenal fistula after gastrectomy: Retrospective study of 13 new cases. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2016; 108:20-6. [PMID: 26765231 DOI: 10.17235/reed.2015.3928/2015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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.
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Affiliation(s)
| | - Pablo Priego
- Cirugía General y Digestivo, Hospital Ramón y Cajal, España
| | - Diego Ramos
- Hospital Universitario Ramón y Cajal. Madrid
| | | | | | | | | | | | - Pedro Carda
- Hospital Universitario Ramón y Cajal. Madrid
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10
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Aurello P, Sirimarco D, Magistri P, Petrucciani N, Berardi G, Amato S, Gasparrini M, D’Angelo F, Nigri G, Ramacciato G. Management of duodenal stump fistula after gastrectomy for gastric cancer: Systematic review. World J Gastroenterol 2015; 21:7571-7576. [PMID: 26140005 PMCID: PMC4481454 DOI: 10.3748/wjg.v21.i24.7571] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/14/2015] [Accepted: 04/09/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify the most effective treatment of duodenal stump fistula (DSF) after gastrectomy for gastric cancer.
METHODS: A systematic review of the literature was performed. PubMed, EMBASE, Cochrane Library, CILEA Archive, BMJ Clinical Evidence and UpToDate databases were analyzed. Three hundred eighty-eight manuscripts were retrieved and analyzed and thirteen studies published between 1988 and 2014 were finally selected according to the inclusion criteria, for a total of 145 cases of DSF, which represented our group of study. Only patients with DSF after gastrectomy for malignancy were selected. Data about patients’ characteristics, type of treatment, short and long-term outcomes were extracted and analyzed.
RESULTS: In the 13 studies different types of treatment were proposed: conservative approach, surgical approach, percutaneous approach and endoscopic approach (3 cases). The overall mortality rate was 11.7% for the entire cohort. The more frequent complications were sepsis, abscesses, peritonitis, bleeding, pneumonia and multi-organ failure. Conservative approach was performed in 6 studies for a total of 79 patients, in patients with stable general condition, often associated with percutaneous approach. A complete resolution of the leakage was achieved in 92.3% of these patients, with a healing time ranging from 17 to 71 d. Surgical approach included duodenostomy, duodeno-jejunostomy, pancreatoduodenectomy and the use of rectus muscle flap. In-hospital stay of patients who underwent relaparotomy ranged from 1 to 1035 d. The percutaneous approach included drainage of abscesses or duodenostomy (32 cases) and percutaneous biliary diversion (13 cases). The median healing time in this group was 43 d.
CONCLUSION: Conservative approach is the treatment of choice, eventually associated with percutaneus drainage. Surgical approach should be reserved for severe cases or when conservative approaches fail.
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Vasiliadis K, Fortounis K, Kokarhidas A, Papavasiliou C, Nimer AA, Stratilati S, Makridis C. Delayed duodenal stump blow-out following total gastrectomy for cancer: Heightened awareness for the continued presence of the surgical past in the present is the key to a successful duodenal stump disruption management. A case report. Int J Surg Case Rep 2014; 5:1229-33. [PMID: 25437683 PMCID: PMC4275811 DOI: 10.1016/j.ijscr.2014.11.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 11/06/2014] [Accepted: 11/08/2014] [Indexed: 02/07/2023] Open
Abstract
Duodenal stump disruption is not a surgical anachronism, because it still remains one of the most dreadful postgastrectomy complications. Postgastrectomy duodenal stump disruption poses an overwhelming therapeutic challenge. Historical surgical sense and familiarity with the various well established methods for the treatment of duodenal stump disruption can provide to the surgical team the ability to successfully manage this devastating complication.
INTRODUCTION Duodenal stump disruption remains one of the most dreadful postgastrectomy complications, posing an overwhelming therapeutic challenge. PRESENTATION OF CASE The present report describes the extremely rare occurrence of a delayed duodenal stump disruption following total gastrectomy with Roux-en-Y esophagojejunostomy for cancer, because of mechanical obstruction of the distal jejunum resulting in increased backpressure on afferent limp and duodenal stump. Surgical management included repair of distal jejunum obstruction, mobilization and re-stapling of the duodenum at the level of its intact second part and retrograde decompressing tube duodenostomy through the proximal jejunum. DISCUSSION Several strategies have been proposed for the successful management post-gastrectomy duodenal stump disruption however; its treatment planning is absolutely determined by the presence or not of generalized peritonitis and hemodynamic instability with hostile abdomen. In such scenario, urgent reoperation is mandatory and the damage control principle should govern the operative treatment. CONCLUSION Considering that scientific data about duodenal stump disruption have virtually disappeared from the current medical literature, this report by contradicting the anachronism of this complication aims to serve as a useful reminder for gastrointestinal surgeons to be familiar with the surgical techniques that provide the ability to properly manage this dreadful postoperative complication.
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Affiliation(s)
- K Vasiliadis
- First Surgical Department, General Hospital Papageorgiou, West Ring Road, Nea Efkarpia, GR-56 403 Thessaloniki, Greece.
| | - K Fortounis
- First Surgical Department, General Hospital Papageorgiou, West Ring Road, Nea Efkarpia, GR-56 403 Thessaloniki, Greece
| | - A Kokarhidas
- First Surgical Department, General Hospital Papageorgiou, West Ring Road, Nea Efkarpia, GR-56 403 Thessaloniki, Greece
| | - C Papavasiliou
- First Surgical Department, General Hospital Papageorgiou, West Ring Road, Nea Efkarpia, GR-56 403 Thessaloniki, Greece
| | - A Al Nimer
- First Surgical Department, General Hospital Papageorgiou, West Ring Road, Nea Efkarpia, GR-56 403 Thessaloniki, Greece
| | - S Stratilati
- Department of Radiology, General Hospital Papageorgiou, West Ring Road, Nea Efkarpia, GR-56 403 Thessaloniki, Greece
| | - C Makridis
- First Surgical Department, General Hospital Papageorgiou, West Ring Road, Nea Efkarpia, GR-56 403 Thessaloniki, Greece
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Orsenigo E, Bissolati M, Socci C, Chiari D, Muffatti F, Nifosi J, Staudacher C. Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience. Gastric Cancer 2014; 17:733-44. [PMID: 24399492 DOI: 10.1007/s10120-013-0327-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 12/16/2013] [Indexed: 02/06/2023]
Abstract
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 life-threatening 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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Affiliation(s)
- Elena Orsenigo
- Department of Surgery, San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
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13
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Kumar N, Thompson CC. Endoscopic management of complications after gastrointestinal weight loss surgery. Clin Gastroenterol Hepatol 2013; 11:343-53. [PMID: 23142331 DOI: 10.1016/j.cgh.2012.10.043] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 10/23/2012] [Accepted: 10/26/2012] [Indexed: 02/07/2023]
Abstract
As more patients undergo bariatric surgery, gastroenterologists will increasingly encounter variant postsurgical anatomies and postoperative complications. We discuss the diagnosis and management of bleeding, ulcers, foreign bodies, stenoses, leaks, fistulas, pancreaticobiliary diseases, weight regain, and dilated outlets.
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Affiliation(s)
- Nitin Kumar
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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14
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Tucker A, Garstin I. A peculiar cause of bowel obstruction. Int J Surg Case Rep 2013; 4:473-6. [PMID: 23562895 DOI: 10.1016/j.ijscr.2013.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/08/2013] [Accepted: 02/13/2013] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Gallstone disease is one of the most common surgical problems necessitating intervention. It is estimated that approximately 15% of people in the western world will develop gallstones. Of these patients, 35% of patients initially diagnosed with gallstones will later develop a complication which will eventually result in cholecystectomy.(2) One of these complications is gallstone ileus, which is a rare complication associated with high morbidity and mortality, and the diagnosis is often missed.(3) PRESENTATION OF CASE A 66 year old female presented with an acute onset of "colicky" abdominal pain accompanied with vomiting. She had known gallstones diagnosed previously by ultrasound. Her abdomen was generally tender with guarding of the right hypochondrium and absent bowel sounds. DISCUSSION Gallstone ileus accounts for 0.5-4% of all cases of small bowel obstruction, and typically affects females over the age of 65.(3,4) The pathophysiological basis of the disease involves fistulation of the gallstone through the wall of the gallbladder into the bowel, where it becomes impacted and leads to obstruction. Mortality of the condition is not sufficiently reported, but surgical intervention in itself conveys significant morbidity, and mortality has been reported to be 18%.(3,9) CONCLUSION We report a single large gallstone, which we believe to be one of the largest documented in recent literature, resulting in gallstone ileus. We also present a brief synopsis of the diagnosis and management of the condition, which although rare, should be considered by the astute surgical trainee.
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Affiliation(s)
- A Tucker
- Ward C6, Antrim Area Hospital, Bush Road, Antrim BT41 2RL, Northern Ireland, United Kingdom.
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15
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Kumar N, Thompson CC. Endoscopic therapy for postoperative leaks and fistulae. Gastrointest Endosc Clin N Am 2013; 23:123-36. [PMID: 23168123 DOI: 10.1016/j.giec.2012.10.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Endoscopic techniques for the treatment of postoperative fistulae and leaks are rapidly developing. Conventional surgical therapy for postsurgical leaks and fistulae is associated with significant morbidity and mortality. Novel endoscopic therapies have demonstrated safety, despite the inherent challenges of intervention in this patient population, and are steadily building evidence for efficacy relative to surgical management. The article examines endoscopic therapy for leaks and fistulae after esophageal, gastric, bariatric, colonic, and pancreaticobiliary surgery.
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Affiliation(s)
- Nitin Kumar
- Division of Gastroenterology, Brigham and Women's Hospital, Boston, MA 02115, USA
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16
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Stephensen B, Brown J, Lambrianides A. A novel method for managing enterocutaneous fistulae in the open abdomen using a pedicle flap. J Surg Case Rep 2012; 2012:5. [PMID: 24960674 PMCID: PMC3862462 DOI: 10.1093/jscr/2012.6.5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A significant proportion of patients with severe intra-abdominal sepsis are managed by leaving the peritoneal cavity open in an attempt to control the infective process, regardless of aetiology. However, a considerable number of these patients develop enterocutaneous fistulae, which compound the clinical situation and delay closure of the peritoneal cavity. We propose a new method of dealing with such fistulae, by simply fashioning a direct pedicle flap to patch the fistulous opening. This method allows control of the fistula and facilitates early closure of the abdomen.
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Affiliation(s)
| | - J Brown
- Redcliffe Hospital, Queensland, Australia
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17
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Lundy JB, Fischer JE. Historical perspectives in the care of patients with enterocutaneous fistula. Clin Colon Rectal Surg 2011; 23:133-41. [PMID: 21886462 DOI: 10.1055/s-0030-1262980] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Evidence can be found throughout surgical history of how devastating an enterocutaneous fistula (ECF) can be for both patient and surgeon. From antiquity, this complication of abdominal surgery, malignancy, radiation, trauma, or inflammatory processes has been a significant challenge to surgeons due to high associated mortality and significant morbidity. An ECF causes dehydration, malnutrition, skin excoriation, and sepsis, and has profound psychological effects on the patient. Recent mortality rates of patients suffering an ECF approach 20%. The authors illustrate the history of management of patients with ECF and discuss advances in perioperative care including parasurgical care, nutrition, wound care, and the history of surgical techniques.
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Affiliation(s)
- Jonathan B Lundy
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas
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Milias K, Deligiannidis N, Papavramidis TS, Ioannidis K, Xiros N, Papavramidis S. Biliogastric diversion for the management of high-output duodenal fistula: report of two cases and literature review. J Gastrointest Surg 2009; 13:299-303. [PMID: 18825468 DOI: 10.1007/s11605-008-0677-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 08/20/2008] [Indexed: 01/31/2023]
Abstract
High-output duodenal fistula occurs as a result of a duodenal wall defect caused by gastroduodenal surgery, endoscopic sphincterotomy, duodenal injury, and tumors with high morbidity and mortality rate. A new technique for its management is reported along with literature review. This procedure consists of transection of the duodenum 2 cm distally to the pylorus, transection of the common bile duct, and end duodenostomy with or without suturing the duodenal wall defect. The continuity of the alimentary tract is reinstated by an end-to-end duodenojejunostomy, end-to-side choledochojejunostomy, and end-to-side Roux-en-Y jejunojejunostomy, obtaining biliogastric diversion from the duodenum and closure of the fistula. This technique was performed in two patients with excellent results.
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Affiliation(s)
- Konstantinos Milias
- 2nd Surgical Department, 424 General Military Hospital, Thessaloniki, Greece.
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19
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Combined Endoscopic and Percutaneous Treatment of a Duodenocutaneous Fistula Using an Amplatzer Septal Occluder. Cardiovasc Intervent Radiol 2008; 32:356-60. [DOI: 10.1007/s00270-008-9433-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2008] [Revised: 08/21/2008] [Accepted: 09/03/2008] [Indexed: 11/25/2022]
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Zarzour JG, Christein JD, Drelichman ER, Oser RF, Hawn MT. Percutaneous transhepatic duodenal diversion for the management of duodenal fistulae. J Gastrointest Surg 2008; 12:1103-9. [PMID: 18172607 DOI: 10.1007/s11605-007-0456-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Accepted: 11/29/2007] [Indexed: 01/31/2023]
Abstract
PURPOSE The aim of this study was to determine the success of the nonoperative management of persistent duodenal fistulae (DF) with percutaneous transhepatic duodenal diversion (PTDD). METHODS Retrospective chart review identified six patients with DF managed by PTDD from 2006 to 2007. Patient outcomes and complications were assessed. RESULTS The etiology of DF included pancreatic surgery (three patients), gastrectomy (two patients), and Crohn's disease (one patient). PTDD was performed by interventional radiology at a median time of 37 days after fistula recognition. After PTDD, fistula drainage decreased from 775 cc/day (range 200 to 2,525 cc/day) to <50 cc/day at a median of 8 days. Patients were discharged 32 days (median) after PTDD. One patient with Crohn's disease required definitive surgical treatment. Of the remaining five patients, the PTDD tube was capped at 27 days (median) after placement and was removed on an outpatient basis at 79 days (median) after placement. There was no mortality, no fistula recurrence, or complications associated with PTDD placement. CONCLUSIONS We present an algorithm for the nonoperative management of persistent postoperative DF. In this limited series, PTDD was highly effective at definitively treating DF, especially in the acute setting. PTDD should be considered by surgeons facing the management of postoperative DF.
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Affiliation(s)
- Jessica G Zarzour
- Section of Gastrointestinal Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Saida Y, Sumiyama Y, Nagao J, Nakamura Y, Nakamura Y, Katagiri M, Watanabe M, Kusachi S. THERAPEUTIC FISTULOSCOPY FOR THE MANAGEMENT OF PROLONGED POSTOPERATIVE INTRA-ABDOMINAL ABSCESS CAUSED BY SMALL INTESTINAL PINHOLE PERFORATION. Dig Endosc 2005. [DOI: 10.1111/j.1443-1661.2005.00556.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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23
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Mui LM, Wong SKH, Ng EKW, Chan ACW, Chung SCS. Combined sinus tract endoscopy and endoscopic retrograde cholangiopancreatography in management of pancreatic necrosis and abscess. Surg Endosc 2004; 19:393-7. [PMID: 15573237 DOI: 10.1007/s00464-004-9120-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2004] [Accepted: 08/05/2004] [Indexed: 01/26/2023]
Abstract
BACKGROUND We report our experience of sinus tract endoscopy (STE) and endoscopic retrograde cholangiopancreatography (ERCP) in the treatment of pancreatic necrosis and abscess. METHODS Thirteen patients with extensive pancreatic necrosis were firstly managed with either percutaneous drainage (PD group; n = 9) or open necrosectomy (ON group; n = 4). Debridement of necrotic tissue was subsequently performed via the drain tract by STE. ERCP was performed only when there was a suspicious of persistent pancreatic duct disruption or choledocholithiasis. RESULTS In the PD group, the median number of STE sessions required was 3 (range 2-8). The median hospital and ICU stay were 84 days (range 29-163 days) and 0 day (range 0-64 days), respectively, with an overall success rate of 67%. In the ON group, the median number of STE sessions required was 6.5 (range 1-18). The median hospital and ICU stay were 82 days (range 58-194 days) and 19 days (range 4-24 days), respectively. No mortality or failure was noted in the latter group. ERCP was required in nine of 13 patients. CONCLUSION Combined ERCP and STE is a useful adjunct in treating pancreatic necrosis or abscess.
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Affiliation(s)
- L M Mui
- Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China
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24
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Petersen B, Barkun A, Carpenter S, Chotiprasidhi P, Chuttani R, Silverman W, Hussain N, Liu J, Taitelbaum G, Ginsberg GG. Tissue adhesives and fibrin glues. Gastrointest Endosc 2004; 60:327-33. [PMID: 15332018 DOI: 10.1016/s0016-5107(04)01564-0] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Halttunen J, Sirén J, Kivilaakso E. Gastrostomy tube insertion into intestinal-cutaneous tract fistulas is a new technique to improve fistula control. Dig Surg 2003; 20:516-9. [PMID: 14534373 DOI: 10.1159/000073687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2003] [Accepted: 07/08/2003] [Indexed: 12/10/2022]
Abstract
BACKGROUND The management of gastrointestinal-cutaneous fistulas may be complicated by the difficulty in obtaining adequate control of the fistula tract. This study describes a new method to obtain better fistula control utilizing a semi-rigid stent in the form of a gastrostomy tube. METHODS Consecutive patients with intestinal-cutaneous fistulas of at least 3 weeks duration and treated by the new technique were analyzed. The technique involved the insertion of a guide wire into the fistula tract from the luminal side using an endoscope, snaring the wire with a Dormia basket inserted into the fistula tract from the cutaneous side and then exteriorized. The gastrostomy tube was then pulled with the guide wire from the lumen along the fistula tract and out through the skin. RESULTS Five patients had had fistulas for a median duration of 42 (range 26-140) days before insertion of the gastrostomy tube. The gastrostomy tube was replaced with a smaller diameter tube in 4 of the patients (range 1-3 changes). The patients were discharged from the hospital at a median of 14 (range 12-23) days after the tube insertion but with the tube in situ. The median time from the insertion of the tube to its removal was 42 (range 32-108) days. CONCLUSIONS Gastrostomy tube insertion using minimally invasive techniques may improve fistula control enabling patients to be discharged home sooner than otherwise and improve the rate of healing.
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Affiliation(s)
- Jorma Halttunen
- Department of Gastroenterological and General Surgery, University of Helsinki, Meilahti Hospital, Helsinki, Finland.
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Eleftheriadis E, Kotzampassi K. Therapeutic fistuloscopy: an alternative approach in the management of postoperative fistulas. Dig Surg 2002; 19:230-5; discussion 236. [PMID: 12119527 DOI: 10.1159/000064218] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND/AIM Since the treatment of postoperative fistulas remains a difficult problem, we applied endoscopic treatment in such 14 persistent fistulas. METHODS Fourteen patients presented with postoperative fistulas: 7 patients (low-output group) due to residual cavity after liver hydatid disease surgery and 7 patients (high-output group) after small-bowel resection (n = 3), diverted duodenostomy (n = 1), vertical gastroplasty (n = 1), external pancreatic cyst drainage (n = 1), and transduodenal sphincteroplasty (n = 1). The therapeutic procedures included mechanical removal of silk sutures, necrotic material, and hydatid membranes in the low-output group and fibrin sealing in the high-output group. RESULTS Fistuloscopy was performed 170-278 days (mean +/- SD 198.7 +/- 36.7 days) and 18-51 days (mean +/- SD 34.0 +/- 11.3 days) postoperatively in low- and high-output fistula patients, respectively, when the average daily output was 20-50 (32.8 +/- 12.5) ml and 200-1,000 (563.1 +/- 319.4) ml, respectively. The low-output group needed only one fistuloscopy session, while the other group required a median number of three sessions plus fibrin sealing, the total amount of fibrin glue used per patient being 2-14 (6.5 +/- 4.4) ml. No procedure-related complication occurred. All fistulas except one healed within 10-33 (21.8 +/- 7.9) days and 2-17 (9.2 +/- 5.1) days in low- and high-output groups, respectively. CONCLUSIONS We believe fistuloscopy to be a useful tool in the management of gastrointestinal fistulas, but more experience should be gained in using this technique.
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Abstract
The current clinical management of surgical patients with sepsis is governed by two principles: control of the source of infection and supportive management of the patient until recovery. Recently, there has been renewed interest in the concept of source control-in particular, its importance for evaluating and comparing clinical trials. This brief review highlights some of the developments in the surgical literature. Important recent publications center on source control, the management of systemic inflammatory response syndrome, necrotizing pancreatitis, acute diverticulitis, gastrointestinal fistulas, and the role of laparoscopy in surgical infections. Novel interventions in supportive care are being developed, and their clinical applicability and effectiveness will be improved with increased understanding of the pathophysiology of systemic inflammation.
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Affiliation(s)
- D Danielson
- Department of Surgery, Hennepin County Medical Center, Minneapolis, Minnesota, USA
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KAMAT ASHISH, YORK TIMOTHY, DEBORD JOSEPH. ANASTOMOTIC FISTULA AFTER ILEAL LOOP URINARY DIVERSION PRESENTING AS PERSISTENT URETHRAL DRAINAGE. J Urol 2001. [DOI: 10.1016/s0022-5347(05)66563-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- ASHISH KAMAT
- From the Department of Urology, Charleston Area Medical Center, Charleston, West Virginia
| | - TIMOTHY YORK
- From the Department of Urology, Charleston Area Medical Center, Charleston, West Virginia
| | - JOSEPH DEBORD
- From the Department of Urology, Charleston Area Medical Center, Charleston, West Virginia
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KAMAT ASHISH, YORK TIMOTHY, DEBORD JOSEPH. ANASTOMOTIC FISTULA AFTER ILEAL LOOP URINARY DIVERSION PRESENTING AS PERSISTENT URETHRAL DRAINAGE. J Urol 2001. [DOI: 10.1097/00005392-200103000-00048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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