A Ten-Year Retrospective Review: Does Pyloric Exclusion Improve Clinical Outcome After Penetrating Duodenal and Combined Pancreaticoduodenal Injuries?

Abstract

In our study population, the performance of pyloric exclusion for penetrating advanced duodenal injury and combined pancreatic and duodenal injuries did not improve clinical outcome. The trend toward a greater overall complication rate, pancreatic fistula rate, and increased length of hospital stay in the pyloric exclusion group suggests that simple repair without pyloric exclusion is both adequate and safe for most penetrating duodenal injuries.

The use of pyloric exclusion for treating duodenal trauma: case series

“…The authors concluded that simple repair without pyloric exclusion was both adequate and safe for most penetrating duodenal injuries. 7 Their report presented significant study limitations, as recognized by the authors. It was retrospective and the patients were not randomized, thus suggesting that pyloric exclusion could have been applied to higher-risk patients.…”

“…The overall mortality rate for duodenal injuries remains between 5.3% and 30%, but injuries to the duodenum itself are responsible for a mortality rate of about 10%. 1,2,4 A recent study by Seamon et al 7 examined patients with penetrating duodenal injuries of grade ≥ II and pancreaticoduodenal injuries, excluding patients who died within 48 hours due to massive associated injuries. Fifteen out of their 29 patients were treated without pyloric exclusion and 14 with exclusion, and the groups were similar with regard to sex, age, mechanism, hemodynamic stability, injury grade (a trend toward greater injury severity was noted in the pyloric exclusion group), ISS, associated abdominal injuries and mortality rates.…”

“…Many authors have advocated the use of pyloric exclusion and have considered it to be the procedure of choice for patients with severe duodenal trauma. 6,7,[16][17][18][19][20] In our study, pyloric exclusion was performed on 8.6% of all the patients with duodenal injury, and we believe that the procedure was a reasonable management method, except in one patient with hypovolemic shock. Vaughan et al 6 used pyloric exclusion on 75 patients selected from a total of 175 (42.9%) presenting with duodenal trauma, and had a mortality rate of 19% and a fistula formation rate of 5%.…”

“…However, the current philosophy for the management of pancreaticoduodenal injuries is that less treatment is probably the best treatment. 7 …”

Trauma de duodeno: análise de fatores relacionados à morbimortalidade

“…Degiannis et al 26 , em estudo em que indicaram a exclusão pilórica, concluíram que este procedimento deve ser indicado em lesões Grau III causadas por FPAF. Já Seamon et al 27 compararam retrospectivamente em pacientes com trauma penetrante de duodeno Grau > II ou lesões duodenopancreáticas, o reparo primário associado ou não à exclusão pilórica, e observaram uma maior incidência de complicações em pacientes tratados com exclusão pilórica, desaconselhando o uso deste procedimento. Atualmente existem na literatura controvérsias sobre o uso de exclusão pilórica, e estudos prospectivos se fazem necessários para dirimir estas dúvidas.…”