Duodenal fistula after gastrectomy: retrospective study of 13 new cases

Revista Espanola de Enfermedades Digestivas

Araceli Ballestero¹  Eduardo Lobo¹  Pedro Carda¹  Magdalena Coll¹  Julio Galindo¹  Gloria Rodríguez¹  Pablo Priego¹  Diego Ramos¹  María de los Ángeles Cornejo¹  Francisca García-Moreno¹ 

[1] Hospital Universitario Ramón y Cajal;

关键词: Cáncer gástrico;    Cirugía;    Fístula muñón duodenal;    Morbilidad;    Mortalidad;    Tratamiento;    Factores de riesgo;    Gastrectomía;   

DOI  :  

来源: DOAJ

【 摘 要 】

Introduction: Duodenal stump fistula (DSF) after gastrectomy has a low incidence but a high morbidity and mortality, and is therefore one of the most aggressive and feared complications of this procedure. Material and methods: We retrospectively evaluated all DSF occurred at our hospital after carrying out a gastrectomy for gastric cancer, between January 1997 and December 2014. We analyzed demographic, oncologic, and surgical variables, and the evolution in terms of morbidity, mortality and hospital stay. Results: In the period covered in this study, we performed 666 gastrectomies and observed DSF in 13 patients (1.95%). In 8 of the 13 patients (61.5%) surgery was the treatment of choice and in 5 cases (38.5%) conservative treatment was carried out. Postoperative mortality associated with DSF was 46.2% (6 cases). In the surgical group, 3 patients developed severe sepsis with multiple organ failure, 2 patients presented a major hematemesis which required endoscopic haemostasis, 1 patient had an evisceration and another presented a subphrenic abscess requiring percutaneous drainage. Six patients (75%) died despite surgery, with 3 deaths in the first 24 hours of postoperative care. The 2 patients who survived after the second surgical procedure had a hospital stay of 45 and 84 days respectively. In the conservative treatment group the cure rate was 100% with no significant complications and an average postoperative hospital stay of 39.5 days (range, 26-65 days). Conclusion: FMD is an unusual complication but it is associated with a high morbidity and mortality. In our experience, conservative management has shown better results compared with surgical treatment.

【 授权许可】

Unknown