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BMC Surgery Apr 2024This study introduced the modified Q-type purse-string suture duodenal stump embedding method, a convenient way to strengthen the duodenum, and compared it to the...
OBJECTIVE
This study introduced the modified Q-type purse-string suture duodenal stump embedding method, a convenient way to strengthen the duodenum, and compared it to the conventional one to assess its efficacy and safety.
METHODS
This retrospective analysis examined 612 patients who received laparoscopic gastrectomy for gastric Cancer at a single center. The patients were divided into Not Reinforced Group (n = 205) and Reinforced Group (n = 407) according to the surgical approach to the duodenal stump. The reinforced group was further divided into a modified Q-type purse-string suture embedding method group (QM, n = 232) and a conventional suture duodenal stump embedding method group (CM, n = 175) according to the methods of duodenal stump enhancement. Clinicopathological characteristics, operative variables, and short-term complications were documented and analyzed.
RESULTS
The incidence of duodenal stump leakage(DSL) in the Not Reinforced Group was higher compared to the Reinforced Group, although the difference was not statistically significant [2.4% (5/205) vs 0.7% (3/407), p = 0.339]. Additionally, the Not Reinforced Group exhibited a higher rate of Reoperation due to DSL compared to the Reinforced Group [2 (1.0%) vs. 0, p = 0.046], with one patient in the Not Reinforced Group experiencing mortality due to DSL [1 (0.5%) vs 0, p = 0.158]. Subgroup analysis within the Reinforced Group revealed that the modified Q-type purse-string suture embedding group (QM) subgroup demonstrated statistically significant advantages over the conventional suture embedding group (CM) subgroup. QM exhibited shorter purse-string closure times (4.11 ± 1.840 vs. 6.05 ± 1.577, p = 0.001), higher purse-string closure success rates (93.1% vs. 77.7%, p = 0.001), and greater satisfaction with purse-string closure [224 (96.6%) vs 157 (89.7%), p = 0.005]. No occurrences of duodenal stump leakage were observed in the QM subgroup, while the CM subgroup experienced two cases [2 (1.1%)], though the difference was not statistically significant. Both groups did not exhibit statistically significant differences in secondary surgery or mortality related to duodenal stump leakage.
CONCLUSION
Duodenal Stump Leakage (DSL) is a severe but low-incidence complication. There is no statistically significant relationship between the reinforcement of the duodenal stump and the incidence of DSL. However, laparoscopic reinforcement of the duodenal stump can reduce the severity of fistulas and the probability of Reoperation. The laparoscopic Q-type purse-string suture duodenal stump embedding method is a simple and effective technique that can, to some extent, shorten the operation time and enhance satisfaction with purse-string closure. There is a trend towards reducing the incidence of DSL, thereby improving patient prognosis to a certain extent.
Topics: Humans; Gastrectomy; Laparoscopy; Stomach Neoplasms; Female; Retrospective Studies; Male; Suture Techniques; Middle Aged; Aged; Duodenum; Treatment Outcome; Adult; Postoperative Complications
PubMed: 38658911
DOI: 10.1186/s12893-024-02423-1 -
The Israel Medical Association Journal... Oct 2002
Topics: Adult; Aorta, Abdominal; Aortic Diseases; Arterial Occlusive Diseases; Blood Vessel Prosthesis Implantation; Candidiasis; Duodenal Diseases; Endoscopy, Gastrointestinal; Femoral Artery; Follow-Up Studies; Humans; Iliac Artery; Intestinal Fistula; Male; Polytetrafluoroethylene; Prosthesis-Related Infections; Time Factors; Vascular Fistula
PubMed: 12389352
DOI: No ID Found -
Revista Espanola de Enfermedades... Mar 2015
Topics: Cholecystectomy, Laparoscopic; Cholecystitis; Duodenal Diseases; Endoscopy; Fistula; Humans; Intestinal Fistula; Jejunoileal Bypass; Male; Middle Aged; Minimally Invasive Surgical Procedures; Obesity; Postoperative Complications
PubMed: 25733046
DOI: No ID Found -
Medicine Jul 2023Fistula formation from intraductal papillary mucinous neoplasm (IPMN) of the pancreas is uncommon; however, IPMN penetrating various organs has been increasingly... (Review)
Review
INTRODUCTION
Fistula formation from intraductal papillary mucinous neoplasm (IPMN) of the pancreas is uncommon; however, IPMN penetrating various organs has been increasingly reported. To date, there is a lack of literature reviewing recent reports and the clinicopathologic details of IPMN with fistula formation are still poorly understood.
METHODS
This study describes the case of a 60-year-old woman presenting with postprandial epigastric pain and diagnosed with main-duct (MD) IPMN penetrating to the duodenum, and presents comprehensive literature review of IPMN with fistulae. A literature review was performed using PubMed for all articles in English using predetermined search terms, including (fistula or fistulization), (pancreas or pancreatic or pancreato or pacreatico), (intraductal papillary mucinous), and (neoplasm or tumor or carcinoma or cancer).
RESULTS
A total of 83 cases and 119 organs were identified in 54 articles. Affected organs were as follows: the stomach (34%), duodenum (30%), bile duct (25%), colon (5%), small intestine (3%), spleen (2%), portal vein (1%), and chest wall (1%). Fistula formation into multiple organs was detected in 35% of cases. Approximately one-third of the cases had tumor invasion around the fistula. MD and mixed type IPMN accounted for 82% of cases. IPMN with high-grade dysplasia or invasive carcinoma were over three times more common than IPMN without these components.
DISCUSSION AND CONCLUSION
Based on the pathological examination of the surgical specimen, this case was diagnosed of MD-IPMN with invasive carcinoma and mechanical penetration or autodigestion was considered as the mechanism of fistula formation. Given the high risk of malignant transformation and intraductal dissemination of the tumor cells, aggressive surgical strategies, such as total pancreatectomy, should be recommended to achieve complete resection for MD-IPMN with fistula formation.
Topics: Female; Humans; Middle Aged; Carcinoma, Pancreatic Ductal; Pancreatic Intraductal Neoplasms; Pancreatic Neoplasms; Pancreas; Pancreatectomy; Fistula
PubMed: 37417614
DOI: 10.1097/MD.0000000000034288 -
Chirurgia (Bucharest, Romania : 1990) 2016The risk of digestive fistula in patients operated for gastric neoplasm is increased due to biological imbalances generated by the cancer's progression, by diagnosis in...
UNLABELLED
The risk of digestive fistula in patients operated for gastric neoplasm is increased due to biological imbalances generated by the cancer's progression, by diagnosis in advanced stages, and by the scale of intervention. Under these circumstances the use of some technical means to protect digestive sutures in these patients is useful.
AIM
To analyse the efficiency of technical means to protect the digestive sutures in patients operated in various stages of development of gastric cancer. Material and We conducted a retrospective study on a group of 130 patients operated for gastric cancer in the 1st General Surgery and Oncology Clinic of the Bucharest Institute of Oncology, between 2010-2014. 38.46% of the patients in the study group presented stage IV cancer with multiple complications and biological imbalances. 52 total gastrectomies and 40 gastric resections were carried out, while in 34 patients palliative "tumour excisions" or other types of palliative surgery were performed. In 15 of the cases with gastric resection a duodenal decompression probe was used, while in 13 of the patients with total gastrectomy an oeso-jejunal aspiration probe together with an oeso-jejunal feeding probe were used as additional technical measures to prevent fistula formation. The incidence of duodenal stump fistula was 7.69%, that of oeso-jejunal anastomosis fistula was 2.3%, with an overall mortality of 3.07% and that of gastro-jejunal anastomosis fistula was 0.76%.
CONCLUSION
Given the risk of fistula development in patients with gastric cancer, as well as the increased risk in advanced stages of cancer development, we consider that the use of technical means of protection of digestive sutures is beneficial and opportune, lowering the incidence of fistulas, reducing their output, pathophysiological effects, and mortality.
Topics: Anastomosis, Surgical; Decompression, Surgical; Digestive System Fistula; Gastrectomy; Gastric Fistula; Humans; Incidence; Intestinal Fistula; Neoplasm Staging; Retrospective Studies; Romania; Stomach Neoplasms; Treatment Outcome
PubMed: 27819638
DOI: 10.21614/chirurgia.111.5.400 -
Revue Medicale de Liege May 2016We report the case of a patient admitted with upper gastrointestinal bleeding. The CT scan revealed an aorto-duodenal fistula. This case highlights the progression of... (Review)
Review
We report the case of a patient admitted with upper gastrointestinal bleeding. The CT scan revealed an aorto-duodenal fistula. This case highlights the progression of radiological imaging in parallel with the clinical course. We take this opportunity to write a brief literature review mainly focused on the description and diagnostic modalities of aortoenteric fistulas.
Topics: Aged; Aorta, Abdominal; Aortic Diseases; Fatal Outcome; Gastrointestinal Hemorrhage; Humans; Intestinal Fistula; Male; Prognosis; Vascular Fistula
PubMed: 27337841
DOI: No ID Found -
Medicine Jul 2022Duodenal stump fistula (DSF) is one of the most serious complications of gastrectomy. The mean time to diagnosis of DSF is approximately 9 days after operation. Our...
Duodenal stump fistula (DSF) is one of the most serious complications of gastrectomy. The mean time to diagnosis of DSF is approximately 9 days after operation. Our report describes an extremely rare case of delayed DSF 144 days after a laparoscopic distal gastrectomy. A 58-year-old man with drug-induced liver cirrhosis (Child-Pugh class A) underwent laparoscopic distal gastrectomy with Billroth-II reconstruction for early gastric cancer. On postoperative day 1, he underwent reoperation because of intra-abdominal bleeding. Ongoing bleeding was observed in the stapler line of the duodenal stump and was controlled using metallic surgical clips. The patient was discharged on postoperative day 14, without complications. After 144 days following the first operation, he visited the emergency room with right flank pain and high fever. Computed tomography revealed free air and abscess near the duodenal stump site. Emergency laparotomy, abscess unlooping, and drain insertion were performed. After surgery, bile was drained by intra-abdominal drainage, and fistulography showed a duodenal fistula. The patient was discharged 55 days after his third surgery. This is an extremely rare case of DSF, which may be caused by the metallic surgical clips used for hemostasis of the duodenal stump stapler line. We believe that the use of metallic surgical clips for hemostasis of the duodenal stump after Billroth-II reconstruction should be avoided.
Topics: Abscess; Duodenal Diseases; Gastrectomy; Humans; Intestinal Fistula; Laparoscopy; Male; Middle Aged; Postoperative Complications; Stomach Neoplasms
PubMed: 35801737
DOI: 10.1097/MD.0000000000029732 -
MedGenMed : Medscape General Medicine Aug 2007Secondary aortoenteric fistula (SAF) is an uncommon but very important complication of abdominal aortic reconstruction. The complication often occurs months to years...
Secondary aortoenteric fistula (SAF) is an uncommon but very important complication of abdominal aortic reconstruction. The complication often occurs months to years after aortic surgery. The clinical manifestation of the aortoenteric fistula is always upper gastrointestinal bleeding. Treatment of the disease is early surgical intervention. If operative treatment is not performed promptly, the mortality is high. A case of secondary aortoduodenal fistula found 6 years after aortic reconstructive surgery, with the clinical presentation of upper gastrointestinal bleeding, is presented. On Immediate exploratory laparotomy, the proximal part of abdominal aorta was clamped. Duodenorrhaphy and aortic reconstruction with patch graft at the proximal suture line of aortic prosthesis was performed. Fortunately there was no pus, so tissue culture was not done. The intervention was concluded with an omentoplasty to protect the patch graft and to separate it from duodenorrhaphy. The patient did well after the surgical management. Because of the increasing number of elective aortic aneurysm repairs in the aging population, it is likely that more patients with secondary aortoenteric fistula will present to the clinical physicians in the future. So, a high index of suspicion is necessary for prompt diagnosis and treatment of this life-threatening event.
Topics: Aged; Aorta, Abdominal; Aortic Diseases; Duodenal Diseases; Humans; Intestinal Fistula; Male; Vascular Fistula; Vascular Surgical Procedures
PubMed: 18092031
DOI: No ID Found -
BMJ Case Reports Sep 2022We present the unique case of a gastropericardial fistula with a rare, delayed presentation in a man in his 70s. Relevant surgeries include Watchman Left Atrial...
We present the unique case of a gastropericardial fistula with a rare, delayed presentation in a man in his 70s. Relevant surgeries include Watchman Left Atrial Appendage Closure device placement 1 year prior to arrival and gastric bypass surgery 20 years prior to arrival. The patient presented to the emergency department with weakness, diarrhoea and left knee pain. He was admitted for cellulitis of the left lower extremity, prosthetic septic arthritis of the left knee and group G streptococcus bacteraemia. His hospital course was complicated by acute chest pain and dyspnoea. Imaging revealed pneumopericardium. Oesophagogastroduodenoscopy visualisation confirmed the diagnosis of gastropericardial fistula. The patient could not be transferred to a tertiary centre for definitive management because of the effect of the COVID-19 pandemic on tertiary hospital volumes. After pericardial drainage and administration of antimicrobials without improvement, the patient was discharged to hospice care at his request and died 1 day after discharge.
Topics: COVID-19; Gastric Fistula; Humans; Male; Pandemics; Pericardium; Pneumopericardium
PubMed: 36123006
DOI: 10.1136/bcr-2022-250093 -
BMJ Case Reports Sep 2018Biliary anatomic pathologies are rare disease occurrences that can result from a number of causes, most commonly iatrogenic, infectious and malignant aetiologies....
Biliary anatomic pathologies are rare disease occurrences that can result from a number of causes, most commonly iatrogenic, infectious and malignant aetiologies. Communications between the biliary and bronchial systems are even rarer and few cases have been documented in the literature. The present study describes a case of a 70-year-old man who underwent a pancreaticoduodenectomy (Whipple Procedure) as a curative procedure for an early stage neuroendocrine tumour. He presented nearly a decade after surgery with a communication between the biliary and bronchial tree initially manifesting as bilioptysis. His underlying medical conditions and poor clinical picture made treatment options limited. Therefore, he was treated conservatively with percutaneous biliary balloon dilation of the anastomotic stricture followed by temporary percutaneous internal/external drain and made a full recovery.
Topics: Aged; Ampulla of Vater; Biliary Fistula; Bronchial Fistula; Carcinoma, Neuroendocrine; Common Bile Duct Neoplasms; Dilatation; Drainage; Humans; Male; Pancreaticoduodenectomy; Postoperative Complications; Time Factors
PubMed: 30181397
DOI: 10.1136/bcr-2017-221895