Luca Cozzaglio1, Marco Giovenzana2, Roberto Biffi3, Lorenzo Cobianchi4, Arianna Coniglio5, Massimo Framarini6, Leonardo Gerard7, Luca Gianotti8, Alberto Marchet9, Vincenzo Mazzaferro10, Paolo Morgagni11, Elena Orsenigo12, Stefano Rausei13, Fabrizio Romano8, Fausto Rosa14, Riccardo Rosati15, Francesco Roviello16, Matteo Sacchi17, Emanuela Morenghi18, Vittorio Quagliuolo2. 1. Division of Surgical Oncology, Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano, MI, Italy. felugia@libero.it. 2. Division of Surgical Oncology, Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano, MI, Italy. 3. Division of Abdominal-Pelvic and Minimally Invasive Surgery, European Institute of Oncology, Milan, Italy. 4. Division of General Surgery 1, IRCCS Fondazione Policlinico S. Matteo, University of Pavia, Pavia, Italy. 5. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. 6. Division of Surgery and Advanced Oncological Therapies, G.B. Morgagni-L. Pierantoni Hospital, Forlì, Italy. 7. Division of Surgery, C. Poma Hospital, Mantua, Italy. 8. Unit of Hepatobiliopancreatic Surgery, Department of Surgery and Translational Medicine, S. Gerardo Hospital, University of Milan-Bicocca, Monza, Italy. 9. Department of Surgical Science, University of Padua, Padua, Italy. 10. Division of Gastrointestinal Surgery and Liver Transplantation, IRCCS Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy. 11. Division of Surgery, G.B. Morgagni-L.Pierantoni Hospital, Forlì, Italy. 12. Department of Surgery, Vita-Salute San Raffaele University, Milan, Italy. 13. Department of Surgical Science, Insubria University, Varese, Italy. 14. Division of Digestive Surgery, Department of Surgical Sciences, Policlinico A. Gemelli, Catholic University Sacro Cuore, Rome, Italy. 15. Division of General and Minimally Invasive Surgery, Humanitas Clinical and Research Center, Rozzano, MI, Italy. 16. Division of Surgical Oncology, Department of Human Pathology and Oncology, University of Siena, Siena, Italy. 17. Division of General Surgery, Humanitas Clinical and Research Center, University of Milan, Rozzano, MI, Italy. 18. Department of Biostatistics, Humanitas Clinical and Research Center, Rozzano, MI, Italy.
Abstract
BACKGROUND: Duodenal stump fistula (DSF) is a severe complication of gastrectomy. Although nonsurgical therapy is preferred, surgery is still mandatory in one third of DSF patients. The aim of this article is to analyze the surgical management of DSF and factors related to its outcome. METHODS: We performed a retrospective multicenter study using data from January 1990 to November 2011 in 16 Italian surgery centers. We collected 8,268 elective gastrectomies for malignancies, 7,987 by the laparotomic and 281 by the laparoscopic approach. Two hundred five patients developed a DSF, 75 of whom underwent surgery for DSF. We analyzed mortality and DSF healing time as well as the impact of clinical, oncological, and surgical characteristics. RESULTS: The laparoscopic approach increased the risk of DSF development (odds ratio 5.6, 95% confidence interval 2.7-10.6, P < 0.001). The indication for first DSF surgery was intra-abdominal sepsis; the failure rate was over 30%, associated with the appearance of fistulas of neighboring organs, bleeding, and the need for reoperations. The mortality rate was 28% and was related to the presence of vascular disease (P = 0.04), more than one reoperation (P = 0.05), sepsis (P < 0.001), and renal failure (P < 0.001). Fifty-four patients recovered after a median of 39 days (interquartile range 22-68 days); the need to perform more reoperations (P < 0.01) and the presence of an abdominal abscess (P < 0.01) led to an increase in healing time. CONCLUSIONS: Surgery for DSF has a poor prognosis. Our data will help to identify patients at risk of death, but unfortunately could not establish the best surgical procedure applicable to all cases of DSF.
BACKGROUND: Duodenal stump fistula (DSF) is a severe complication of gastrectomy. Although nonsurgical therapy is preferred, surgery is still mandatory in one third of DSF patients. The aim of this article is to analyze the surgical management of DSF and factors related to its outcome. METHODS: We performed a retrospective multicenter study using data from January 1990 to November 2011 in 16 Italian surgery centers. We collected 8,268 elective gastrectomies for malignancies, 7,987 by the laparotomic and 281 by the laparoscopic approach. Two hundred five patients developed a DSF, 75 of whom underwent surgery for DSF. We analyzed mortality and DSF healing time as well as the impact of clinical, oncological, and surgical characteristics. RESULTS: The laparoscopic approach increased the risk of DSF development (odds ratio 5.6, 95% confidence interval 2.7-10.6, P < 0.001). The indication for first DSF surgery was intra-abdominal sepsis; the failure rate was over 30%, associated with the appearance of fistulas of neighboring organs, bleeding, and the need for reoperations. The mortality rate was 28% and was related to the presence of vascular disease (P = 0.04), more than one reoperation (P = 0.05), sepsis (P < 0.001), and renal failure (P < 0.001). Fifty-four patients recovered after a median of 39 days (interquartile range 22-68 days); the need to perform more reoperations (P < 0.01) and the presence of an abdominal abscess (P < 0.01) led to an increase in healing time. CONCLUSIONS: Surgery for DSF has a poor prognosis. Our data will help to identify patients at risk of death, but unfortunately could not establish the best surgical procedure applicable to all cases of DSF.
Entities:
Keywords:
Complications; Duodenal stump fistula; Gastrectomy; Surgery
Authors: Łukasz Gwozdziewicz; Muhammad Adil Abbas Khan; Łukasz Adamczyk; Stanisław Hać; Robert Rzepko Journal: Surg Innov Date: 2011-12-04 Impact factor: 2.058
Authors: Young-Il Kim; Jong Yeul Lee; Harbi Khalayleh; Chan Gyoo Kim; Hong Man Yoon; Soo Jin Kim; Hannah Yang; Keun Won Ryu; Il Ju Choi; Young-Woo Kim Journal: Surg Endosc Date: 2021-07-12 Impact factor: 4.584