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Gastroenterologie Clinique Et Biologique May 2005Percutaneous endoscopic gastro-jejunostomy is appropriate for patients with severe neurologic deficit to avoid repeated tube feeding-related aspiration. We describe a... (Clinical Trial)
Clinical Trial
OBJECTIVES
Percutaneous endoscopic gastro-jejunostomy is appropriate for patients with severe neurologic deficit to avoid repeated tube feeding-related aspiration. We describe a modified technique of endoscopic gastro-duodenostomy.
PATIENTS AND METHODS
This technique was performed in 9 patients with severe neurologic deficit. No fluoroscopy was necessary. The gastrostomy button was pushed across the pylorus into the bulb; a nasogastric tube was then placed in the duodenum under endoscopic control and the button was drawn to the gastric wall. When the gastroduodenal tube migrated or was occluded, the button was placed in the bulb through the pylorus and maintained in this position for alimentation.
RESULTS
Placement of the gastro-duodenostomy tube was successful without any complication in 100% of patients. The mean duration of the procedure was 15 min. The tube had to be removed for migration (N = 4) and occlusion (N = 5) after a mean period of 5.8 weeks (range: 2-10). During the follow-up period, no tube feeding-related aspiration was observed.
CONCLUSION
This modified low-cost technique of endoscopic gastro-duodenostomy is simple and efficient.
Topics: Duodenostomy; Endoscopy, Digestive System; Enteral Nutrition; Gastrostomy; Humans; Nervous System Diseases
PubMed: 15980742
DOI: 10.1016/s0399-8320(05)82120-7 -
Minnesota Medicine Nov 1960
Topics: Duodenostomy; Minnesota; Peptic Ulcer
PubMed: 13784457
DOI: No ID Found -
Canadian Journal of Surgery. Journal... Feb 2010Much about the etiology, pathophysiology, natural course and optimal treatment of cystic disease of the biliary tree remains under debate. Gastroenterologists, surgeons... (Review)
Review
Much about the etiology, pathophysiology, natural course and optimal treatment of cystic disease of the biliary tree remains under debate. Gastroenterologists, surgeons and radiologists alike still strive to optimize their roles in the management of choledochal cysts. To that end, much has been written about this disease entity, and the purpose of this 3-part review is to organize the available literature and present the various theories currently argued by the experts. In part 3, we discuss the management of choledochal cysts, thus completing our comprehensive review.
Topics: Choledochal Cyst; Duodenostomy; Enterostomy; Female; Hepatic Duct, Common; Humans; Pancreatitis; Pregnancy; Pregnancy Complications
PubMed: 20100414
DOI: No ID Found -
World Journal of Surgery Aug 2007The most successful method of managing the difficult duodenum, including the stump leakage, has been the tube duodenostomy technique, but it has not gained wide...
OBJECTIVE
The most successful method of managing the difficult duodenum, including the stump leakage, has been the tube duodenostomy technique, but it has not gained wide acceptance and is rarely used. The purpose of this study is to describe the details of the procedure for indication, technical approach, and postoperative care.
METHODS
During the period from 1998 to 2006, a tube duodenostomy was performed in 31 patients for possible insecure duodenal stump closure during gastric resection, postoperative duodenal stump leakage, duodenal leak after primary closure of duodenum for perforation or injury, or anostomotic leak after choledochoduodenostomy. All of the tube duodenostomies were performed through the open end of the duodenum. We also inserted a T-tube into the common bile duct in 19 of 31 patients (61.2 %) with tube duodenostomy.
RESULTS
A tube duodenostomy was performed in the primary operation in 15 of 31 patients. None of those 15 patients required a second operation, and there were no leaks and no deaths. Among the larger group (31 patients), there was one (3.2 %) duodenal stump leak after tube duodenostomy, and it ceased spontaneously; one patient had a subhepatic collection after removal of the duodenostomy tube, and three patients had associated incisional infections. Two patients died; one after a myocardial infarction and the other from irreversible sepsis. The mean length of hospital stay was 26.9 days.
CONCLUSIONS
We conclude that tube duodenostomy is a simple, effective, and safe method to prevent rupture of an insecure duodenal stump or to treat the leakage from the duodenal stump or primary repair on the duodenum.
Topics: Adult; Aged; Drainage; Duodenal Diseases; Duodenostomy; Equipment Design; Female; Gastrectomy; Humans; Male; Middle Aged; Postoperative Care; Postoperative Complications; Treatment Outcome
PubMed: 17566821
DOI: 10.1007/s00268-007-9114-3 -
Nihon Geka Gakkai Zasshi Jun 2003A duodenum-preserving pancreatic head resection (DPPHR) was first reported by Beger et al. in 1980. However, its application has been limited to chronic pancreatitis... (Review)
Review
A duodenum-preserving pancreatic head resection (DPPHR) was first reported by Beger et al. in 1980. However, its application has been limited to chronic pancreatitis because of it is a subtotal pancreatic head resection. In 1990, we reported duodenum-preserving total pancreatic head resection (DPTPHR) in 26 cases. This opened the way for total pancreatic head resection, expanding the application of this approach to tumorigenic morbidities such as intraductal papillary mucinous tumor (IMPT), other benign tumors, and small pancreatic cancers. On the other hand, Nakao et al. reported pancreatic head resection with segmental duodenectomy (PHRSD) as an alternative pylorus-preserving pancreatoduodenectomy technique in 24 cases. Hirata et al. also reported this technique as a new pylorus-preserving pancreatoduodenostomy with increased vessel preservation. When performing DPTPHR, the surgeon should ensure adequate duodenal blood supply. Avoidance of duodenal ischemia is very important in this operation, and thus it is necessary to maintain blood flow in the posterior pancreatoduodenal artery and to preserve the mesoduodenal vessels. Postoperative pancreatic functional tests reveal that DPTPHR is superior to PPPD, including PHSRD, because the entire duodenum and duodenal integrity is very important for postoperative pancreatic function.
Topics: Adenocarcinoma, Mucinous; Adenocarcinoma, Papillary; Carcinoma, Pancreatic Ductal; Duodenostomy; Duodenum; Humans; Pancreatectomy; Pancreatic Neoplasms; Pancreaticoduodenectomy; Treatment Outcome
PubMed: 12854495
DOI: No ID Found -
The Journal of Small Animal Practice Apr 1998Five male crossbred dogs successfully underwent surgical placement of button enterostomy tubes to evaluate the placement technique, maintenance and complications of... (Comparative Study)
Comparative Study
Five male crossbred dogs successfully underwent surgical placement of button enterostomy tubes to evaluate the placement technique, maintenance and complications of these tubes. Surgical placement was quick, technically straightforward and similar to techniques used for other feeding tubes. None of the dogs experienced life-threatening complications during the 10 month follow-up period. One device required replacement as it was removed by the dog before a permanent fistula had formed. Open tubes due to loose safety plugs and focal cellulitis surrounding the exit sites of these tubes were noted in all dogs. The button tube may be a feasible option for long-term nutritional support in patients with pancreatic, hepatobiliary or gastrointestinal conditions.
Topics: Animals; Dogs; Duodenostomy; Follow-Up Studies; Jejunostomy; Male; Postoperative Care; Postoperative Complications; Random Allocation; Reoperation
PubMed: 9577761
DOI: 10.1111/j.1748-5827.1998.tb03628.x -
Ulusal Travma Ve Acil Cerrahi Dergisi =... Sep 2009The aim of this study was to report our experience with duodenal injuries and determine if primary repair and/or tube duodenostomy are valid options for definitive...
BACKGROUND
The aim of this study was to report our experience with duodenal injuries and determine if primary repair and/or tube duodenostomy are valid options for definitive operative repair of severe duodenal injuries.
METHODS
Sixty-seven patients who underwent surgery for duodenal injuries were evaluated. Management of duodenal injury was classified as primary repair and tube decompression.
RESULTS
Fifty-nine patients were injured by a penetrating mechanism, and eight were injured by blunt mechanism. The most common injury site was in the second portion of the duodenum. There were no significant differences between the two groups with respect to morbidity and mortality rate. In 35 patients without morbidity, the mean length of hospital stay was 18.53+/-1.85 days in the tube duodenostomy group and 11.45+/-1.92 days in the primary repair group, and the difference was statistically significant. In the 32 patients with morbidity, the mean length of hospital stay was 47.05+/-10.46 days in the tube duodenostomy group and 49.86+/-10.86 days in primary repair group, but there was no statistically significant difference between the groups.
CONCLUSION
Primary repair is suitable in the vast majority of duodenal injuries; tube duodenostomy increases the length of hospital stay and does not improve clinical outcome.
Topics: Abdominal Injuries; Adolescent; Adult; Aged; Duodenostomy; Duodenum; Female; Hematoma; Humans; Lacerations; Length of Stay; Male; Middle Aged; Trauma Severity Indices; Treatment Outcome; Wounds, Nonpenetrating; Wounds, Penetrating; Young Adult
PubMed: 19779988
DOI: No ID Found -
Annals of Transplantation Jan 2017BACKGROUND The surgical technique used in pancreas transplant is essential for patient safety and graft survival, and problems exist with conventional strategies. When...
BACKGROUND The surgical technique used in pancreas transplant is essential for patient safety and graft survival, and problems exist with conventional strategies. When enteric exocrine drainage is performed, there is no method of immunologic monitoring other than direct graft pancreas biopsy. The most common cause of early graft failure is graft thrombosis, and adequate preventive and treatment strategies are unclear. To overcome these disadvantages, we suggest a modified surgical technique. MATERIAL AND METHODS Eleven patients underwent pancreas transplant with our modified technique. The modified surgical techniques are as follows: 1) graft duodenum was anastomosed with recipient duodenum to enable endoscopic immunological monitoring, and 2) the inferior vena cava was chosen for vascular anastomosis and a diamond-shaped patch was applied to prevent graft thrombosis. RESULTS No patient mortality or graft failure occurred. One case of partial thrombosis of the graft portal vein occurred, which did not affect graft condition, and resolved after heparin treatment. All patients were cured from diabetes mellitus. There were no cases of pancreatic rejection, but 2 cases of graft duodenal rejection occurred, which were adequately treated with steroid therapy. CONCLUSIONS This modified surgical technique for pancreas transplant represents a feasible method for preventing thrombosis and allows for direct graft monitoring through endoscopy.
Topics: Adult; Anastomosis, Surgical; Drainage; Duodenostomy; Graft Survival; Humans; Immunosuppressive Agents; Pancreas Transplantation; Postoperative Care
PubMed: 28100901
DOI: 10.12659/aot.901469 -
Pediatric Surgery International Apr 2013Laparoscopy enables surgeons to approach the surgical conditions from a new perspective. Laparoscopic surgery has revolutionized the treatment of choledochal cysts... (Review)
Review
Laparoscopy enables surgeons to approach the surgical conditions from a new perspective. Laparoscopic surgery has revolutionized the treatment of choledochal cysts (CDC). Yet, this new technique requires objective evaluations. We have examined the controversies about the CDC dissection, distal common bile duct ligation, ductoplasty for hepatic duct stenosis, intrahepatic duct and common channel protein plug clearance, timing of surgery for antenatally diagnosed CDC, and the Roux loop length in CDC children. In the hands of experts, laparoscopic excision of the cyst and Roux-en-Y hepaticojejunostomy is a safe and effective approach. We provide our opinions on these issues based on our experience and publications. We conclude that the main outcomes comparable to those of the open surgery. The better wound cosmesis and reduction of surgical trauma are the advantages.
Topics: Biliary Tract Surgical Procedures; Choledochal Cyst; Common Bile Duct; Constriction, Pathologic; Duodenostomy; Humans; Jejunostomy; Laparoscopy; Robotics; Treatment Outcome
PubMed: 23371300
DOI: 10.1007/s00383-013-3266-z -
Der Chirurg; Zeitschrift Fur Alle... Dec 2012Techniques for biliodigestive anastomoses are a frequent indication in primary surgical interventions. Moreover, they are required to manage secondary complications of... (Review)
Review
Techniques for biliodigestive anastomoses are a frequent indication in primary surgical interventions. Moreover, they are required to manage secondary complications of hepatobiliary surgery. Evidence for the management of complications following biliodigestive anastomoses is low. Biliodigestive anastomoses can be performed as hepaticojejunostomy, hepatojejunostomy/portoenterostomy and hepaticoduodenostomy using running or single stitch suture techniques. Complication management in the hands of experienced hepatopancreatobiliary surgeons should consider a time delay to the primary operation and an interdisciplinary surgical and/or endoscopic or radiologic interventional approach. The therapy may be protracted and requires repeated critical reflection of the particular complication.
Topics: Anastomosis, Roux-en-Y; Anastomosis, Surgical; Bile Ducts; Biliary Tract Diseases; Biliary Tract Surgical Procedures; Cooperative Behavior; Drainage; Duodenostomy; Humans; Interdisciplinary Communication; Jejunostomy; Portoenterostomy, Hepatic; Postoperative Complications; Reoperation
PubMed: 23179515
DOI: 10.1007/s00104-012-2365-z