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Gastroenterologia Y Hepatologia Apr 2022
Topics: Biliary Fistula; Duodenal Diseases; Duodenal Ulcer; Duodenum; Humans; Intestinal Fistula
PubMed: 33727008
DOI: 10.1016/j.gastrohep.2021.02.003 -
Annals of Surgery Nov 1950
Topics: Duodenum; Fistula; Humans; Intestinal Fistula
PubMed: 14771800
DOI: 10.1097/00000658-195011000-00005 -
British Journal of Urology Sep 1954
Topics: Duodenal Diseases; Duodenum; Fistula; Kidney
PubMed: 13199275
DOI: 10.1111/j.1464-410x.1954.tb04901.x -
World Journal of Gastroenterology Jun 2015To identify the most effective treatment of duodenal stump fistula (DSF) after gastrectomy for gastric cancer. (Review)
Review
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.
Topics: Anastomotic Leak; Drainage; Duodenal Diseases; Duodenum; Gastrectomy; Humans; Intestinal Fistula; Length of Stay; Reoperation; Stomach Neoplasms; Time Factors; Treatment Outcome; Wound Healing
PubMed: 26140005
DOI: 10.3748/wjg.v21.i24.7571 -
Annali Italiani Di Chirurgia 2022The duodenal «diverticulization» is a surgical technique described by Berne and colleagues in 1968 for the treatment of combined duodenal pancreatic injuries. It... (Review)
Review
BACKGROUND
The duodenal «diverticulization» is a surgical technique described by Berne and colleagues in 1968 for the treatment of combined duodenal pancreatic injuries. It consisted of closure of the duodenal injury by suture and tube duodenostomy, gastric antrectomy with end-to-side isoperistaltic Billroth II gastrojejunostomy, and abdominal drainage. As evidenced from the literature in few reports, this technique has also been adopted for lateral duodenal lacerations in non traumatic conditions. Most biliary disease may be responsible for duodenal injury.
CASE PRESENTATION
Herein, we describe the application of this emergency technique for the treatment of a wide lateral duodenal laceration discovered intra-operatively during laparoscopic cholecystectomy for acute cholecystitis. A comprehensive critical review of the different surgical methods proposed for duodenal protection in case of severe duodenal lesions has been performed and discussed.
CONCLUSION
Duodenal injuries represent a challenging condition, especially for surgeons with limited experience in this field. The key-message of this report is to consider emergency surgical techniques in difficult unexpected intra-operative situations which may occur during routine surgical practice.
KEY WORDS
Duodenal diverticulization, Duodenal fistula, Laparoscopic cholecystectomy, Surgical repair.
Topics: Cholecystectomy, Laparoscopic; Duodenal Diseases; Duodenostomy; Duodenum; Humans; Intestinal Fistula
PubMed: 36056628
DOI: No ID Found -
Asian Journal of Surgery Sep 2022
Topics: Duodenal Diseases; Duodenum; Endoscopy; Humans; Intestinal Fistula; Negative-Pressure Wound Therapy
PubMed: 35599128
DOI: 10.1016/j.asjsur.2022.05.034 -
Journal of the Irish Medical Association Nov 1953
Topics: Duodenal Diseases; Duodenum; Fistula
PubMed: 13109309
DOI: No ID Found -
World Journal of Emergency Surgery :... May 2023A common feature of external duodenal fistulae is the devastating effect of the duodenal content rich in bile and pancreatic juice on nearby tissues with...
INTRODUCTION
A common feature of external duodenal fistulae is the devastating effect of the duodenal content rich in bile and pancreatic juice on nearby tissues with therapy-resistant local and systemic complications. This study analyzes the results of different management options with emphasis on successful fistula closure rates.
METHODS
A retrospective single academic center study of adult patients treated for complex duodenal fistulas over a 17-year period with descriptive and univariate analyses was performed.
RESULTS
Fifty patients were identified. First line treatment was surgical in 38 (76%) cases and consisted of resuture or resection with anastomosis combined with duodenal decompression and periduodenal drainage in 36 cases, rectus muscle patch, and surgical decompression with T-tube in one each. Fistula closure rate was 29/38 (76%). In 12 cases, the initial management was nonoperative with or without percutaneous drainage. The fistula was closed without surgery in 5/6 patients (1 patient died with persistent fistula). Among the remaining 6 patients eventually operated, fistula closure was achieved in 4 cases. There was no difference in successful fistula closure rates among initially operatively versus nonoperatively managed patients (29/38 vs. 9/12, p = 1.000). However, when considering eventually failed nonoperative management in 7/12 patients, there was a significant difference in the fistula closure rate (29/38 vs. 5/12, p = 0.036). The overall in-hospital mortality rate was 20/50 (40%).
CONCLUSIONS
Surgical closure combined with duodenal decompression in complex duodenal leaks offers the best chance of successful outcome. In selected cases, nonoperative management can be tried, accepting that some patients may require surgery later.
Topics: Adult; Humans; Retrospective Studies; Duodenal Diseases; Duodenum; Intestinal Fistula; Anastomosis, Surgical
PubMed: 37208716
DOI: 10.1186/s13017-023-00503-w -
Endoscopy Sep 2022
Topics: Cutaneous Fistula; Drainage; Duodenum; Endoscopy; Humans; Intestinal Fistula; Negative-Pressure Wound Therapy
PubMed: 34624919
DOI: 10.1055/a-1638-8725 -
Khirurgiia 2016
Topics: Abdominal Injuries; Disease Management; Duodenal Diseases; Duodenum; Humans; Intestinal Fistula; Laparotomy; Male; Reoperation; Treatment Outcome; Young Adult
PubMed: 27459492
DOI: 10.17116/hirurgia2016777-79