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AJR. American Journal of Roentgenology Jan 2001
Topics: Adult; Duodenostomy; Enteral Nutrition; Humans; Male; Punctures; Radiography, Interventional
PubMed: 11133559
DOI: 10.2214/ajr.176.1.1760159 -
Endoscopy Feb 2017
Topics: Aged, 80 and over; Cholecystostomy; Duodenostomy; Endoscopy, Gastrointestinal; Endosonography; Female; Gallstones; Humans; Lithotripsy; Stents; Ultrasonography, Interventional
PubMed: 28226389
DOI: 10.1055/s-0043-102394 -
Nutrition (Burbank, Los Angeles County,... Sep 2015After gastrectomy, the remnant stomach, a small stomach behind the lateral segment of the liver, is thought to be a relative contraindication to receiving a percutaneous...
After gastrectomy, the remnant stomach, a small stomach behind the lateral segment of the liver, is thought to be a relative contraindication to receiving a percutaneous endoscopy-guided gastrostomy (PEG). We successfully performed a percutaneous duodenostomy in a case with remnant stomach. We used a transhepatic pull method with computed tomography (CT) guidance and real-time visualization by using ultrasound (US) and an endoscopy. The procedure was as follows: 1. Full stretching of the remnant stomach; 2. Insertion of a fine injection needle into the duodenal lumen through the lateral segment of the liver without an intrahepatic vascular and biliary injury using real-time visualization through US; 3. Confirmation of the location of the fine needle using abdominal CT, which showed the fine needle penetrating through the lateral segment and the duodenal lumen; 4. Insertion of the thick needle of the PEG kit just laterally of the fine needle; 5. Confirmation of the location of the thick needle using a repeated CT; 6. Endoscopic confirmation of the location of the two needles; 7. Changing the direction of the thick needle using guidance with endoscopy, inserting the thick needle into the duodenal lumen, and removing the fine needle; 8. Insertion of the guide wire through the thick needle; and 9. Placement of the PEG tube using the pull method. Using a real-time US scan, we detected the puncture of the anterior wall of the duodenum or stomach and avoided intrahepatic major vascular and biliary injuries.
Topics: Aged, 80 and over; Duodenostomy; Duodenum; Endoscopy, Gastrointestinal; Enteral Nutrition; Gastrectomy; Gastrostomy; Humans; Liver; Male; Stomach; Ultrasonography
PubMed: 26233876
DOI: 10.1016/j.nut.2015.04.004 -
Journal of Pediatric Surgery Jul 1989Biliary conduits constructed during operations for choledochal cysts or biliary atresia are frequently complicated by reflux of gastrointestinal contents, stasis, and...
Biliary conduits constructed during operations for choledochal cysts or biliary atresia are frequently complicated by reflux of gastrointestinal contents, stasis, and obstruction with resulting cholangitis. We have used the appendix as a biliary conduit for cases of biliary atresia and choledochal cyst, adapting the urologic technique of a tunneled, nonrefluxing anastomosis for reconstruction of the biliary tree--biliary appendico-duodenostomy (BAD). From our preliminary experience with this technique, it appears promising.
Topics: Anastomosis, Surgical; Appendix; Bile Ducts; Biliary Atresia; Child, Preschool; Common Bile Duct Diseases; Cysts; Duodenostomy; Duodenum; Enterostomy; Humans; Infant, Newborn; Male; Surgical Staplers
PubMed: 2754583
DOI: 10.1016/s0022-3468(89)80715-8 -
Die Medizinische Welt Feb 1965
Topics: Ampulla of Vater; Cholecystectomy; Cicatrix; Duodenostomy; Duodenum; Gallbladder; Humans; Surgical Procedures, Operative
PubMed: 14263591
DOI: No ID Found -
Clinical Transplantation 2012Enteric drainage (ED) using duodenojejunostomy (DJ) is an established technique in pancreatic transplantation. Duodenoduodenostomy (DD), an alternative ED technique, may...
Enteric drainage (ED) using duodenojejunostomy (DJ) is an established technique in pancreatic transplantation. Duodenoduodenostomy (DD), an alternative ED technique, may provide unique advantages over DJ. We compared our experience with these two types of ED through a retrospective review of all pancreas transplants performed at our institution from November 2007 to November 2009. The allograft duodenum was anastomosed to the recipient jejunum or duodenum. Duodenal drainage was performed by a stapled or hand-sewn technique. Patient demographics, operative times, major post-operative complications, and graft survival data were analyzed. Of 57 pancreas transplants, DJ was performed in 36 patients, stapled DD in 14 patients, and hand-sewn DD in seven patients. Two DD grafts (9.5%) thrombosed compared with no DJ grafts (p = NS). Enteric leak and small-bowel obstruction occurred in 3 of 36 DJ patients and in two DD patients (p = NS). Gastrointestinal bleeding occurred more frequently in stapled DD compared with DJ (4 vs. 0, p < 0.015). In conclusion, DD is technically feasible with no increase in operative time or enteric complications. GI bleeding rates appear to be higher following DD (stapled) technique. Potential complications of DD should be balanced against the benefits conferred by this technique.
Topics: Adult; Anastomosis, Surgical; Drainage; Duodenostomy; Duodenum; Female; Follow-Up Studies; Graft Survival; Humans; Jejunum; Male; Middle Aged; Pancreas Transplantation; Postoperative Complications; Prognosis; Retrospective Studies; Survival Rate; Transplantation, Homologous; Young Adult
PubMed: 22126588
DOI: 10.1111/j.1399-0012.2011.01563.x -
International Journal of Surgery... Dec 2017Controversy exists regarding the best anastomotic method for pancreaticoduodenectomy (PD). We aimed to evaluate the perioperative outcomes of PD with stapled anastomosis... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Controversy exists regarding the best anastomotic method for pancreaticoduodenectomy (PD). We aimed to evaluate the perioperative outcomes of PD with stapled anastomosis (SA) versus hand-sewn anastomosis (HA) of gastrojejunostomy or duodenojejunostomy.
METHODS
We conducted a systematic search of electronic information sources, including MEDLINE; EMBASE; CINAHL; the Cochrane Central Register of Controlled Trials (CENTRAL); the World Health Organization International Clinical Trials Registry; ClinicalTrials.gov; ISRCTN Register, and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Delayed gastric emptying (DGE), postoperative pancreatic fistula (POPF), anastomotic bleeding, anastomotic leak, intra-abdominal abscess and mortality were defined as the outcome parameters. Combined overall effect sizes were calculated using fixed-effect or random-effects models.
RESULTS
We identified 1 randomised controlled trial (RCT) and 5 observational studies reporting a total of 890 patients who underwent PD with SA (n = 300) or conventional HA (n = 590). Our analysis demonstrated that SA significantly reduced postoperative DGE (OR: 0.37, 95% CI 0.25-0.54, P < 0.00001) but significantly increased anastomotic bleeding (OR: 13.4, 95% CI 2.96-57.41, P = 0.0007) compared to HA. No significant difference was found in POPF (OR: 0.83, 95% CI 0.56-1.21, P = 0.33); anastomotic leak (OR: 0.50, 95% CI 0.09-3.79, P = 0.58); intra-abdominal abscess (OR: 1.39, 95% CI 0.71-2.70, P = 0.34); or mortality (RD: -0.01, 95% CI 0.03-0.02, P = 0.65) between two groups.
CONCLUSIONS
Our analysis demonstrated that compared to conventional HA, SA may be associated with lower incidence of DGE after PD without increasing the risk of clinically significant POPF, anastomotic leak or mortality. However, it is associated with higher rate of anastomotic bleeding which mandates careful and precise haemostasis of the stapled line. Considering the current limited evidence, no definitive conclusion can be drawn. Future research is required.
Topics: Abdominal Abscess; Anastomosis, Surgical; Anastomotic Leak; Duodenostomy; Gastric Bypass; Gastroparesis; Humans; Jejunostomy; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Complications; Postoperative Hemorrhage; Surgical Stapling; Surgical Stomas; Suture Techniques; Treatment Outcome
PubMed: 28987557
DOI: 10.1016/j.ijsu.2017.09.071 -
Journal of Pediatric Surgery Nov 2013Excision has been established as a standard management practice for choledochal cysts in the last few decades. The two most commonly performed methods of reconstruction... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Excision has been established as a standard management practice for choledochal cysts in the last few decades. The two most commonly performed methods of reconstruction after excision are hepaticoduodenostomy (HD) and Roux-en-Y hepaticojejunostomy (HJ), of which the HJ is favored by most surgeons. Evidence concerning the optimal method of reconstruction is, however, sparse.
MATERIALS AND METHODS
Studies comparing outcomes from HD and HJ after choledochal cyst excision were identified by searching Medline, Ovid, Search Medica, Elsevier Clinicalkey, Google Scholar and Cochrane library. Suitable studies were chosen and data extracted for meta-analysis. Outcomes evaluated included operative time, hospital stay and incidence of postoperative bile leak, cholangitis, reflux/gastritis, anastomotic stricture, bleeding, intestinal obstruction and re-operative rate. Pooled odds ratios (OR) were calculated for dichotomous variables; pooled mean differences (MD) were measured for continuous variables.
RESULTS
Six retrospective studies were included in this meta-analysis, comprising a total of 679 patients, 412 of whom (60.7%) underwent HD, and the remainder, 267 (39.3%) underwent HJ. Although, HD group had slightly shorter hospital stay (MD: 0.30; 95% CI: -0.22-0.39; P < 0.00001) it showed a higher incidence of postoperative reflux/gastritis (OR: 0.08; 95% CI: -0.02-0.39; P = 0.002). However, the other outcomes such as bile leak, cholangitis, anastomotic stricture, bleeding, operative time, reoperation rate and adhesive intestinal obstruction did not differ between HD and HJ groups.
CONCLUSIONS
HD shows higher postoperative reflux/gastritis than HJ but a shorter hospital stay. There are few good-quality studies that compare the outcomes from HD and HJ, meaning that caution should be exercised in the generalization of the results of this meta-analysis, which suggests HD to be comparable with HJ in terms of other complications, operative benefits and outcomes.
Topics: Anastomosis, Roux-en-Y; Anastomotic Leak; Bile; Cholangitis; Choledochal Cyst; Constriction, Pathologic; Duodenostomy; Gastritis; Humans; Intestinal Obstruction; Jejunostomy; Laparoscopy; Length of Stay; Liver; Operative Time; Postoperative Complications; Reoperation; Retrospective Studies; Treatment Outcome
PubMed: 24210209
DOI: 10.1016/j.jpedsurg.2013.07.020 -
A.M.A. Archives of Surgery Jun 1956
Topics: Digestive System Surgical Procedures; Duodenal Ulcer; Duodenostomy; Duodenum; Gastrectomy; Humans; Intestines; Peptic Ulcer
PubMed: 13312865
DOI: No ID Found -
Gastrointestinal Endoscopy Sep 2016
Topics: Ascites; Bile Duct Neoplasms; Cholangiocarcinoma; Cholangitis, Sclerosing; Cholecystostomy; Cyanoacrylates; Duodenostomy; Endosonography; Female; Gallbladder Diseases; Humans; Liver Cirrhosis; Magnetic Resonance Imaging; Middle Aged; Mycoses; Peritonitis; Stents; Surgery, Computer-Assisted; Surgical Instruments; Tissue Adhesives
PubMed: 27063919
DOI: 10.1016/j.gie.2016.03.1505