Duodenal stump fistula following Roux-en-Y gastrectomy, treated with single-balloon enteroscopy using the tulip bundle technique and fibrin glue injection

Curcio, Gabriele; Badas, Roberta; Miraglia, Roberto; Barresi, Luca; Tarantino, Ilaria; Traina, Mario

doi:10.1055/s-0032-1310073

Cited by 6 publications

(8 citation statements)

References 5 publications

(4 reference statements)

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“…Endoscopic treatment was mentioned in just 4 case report studies [10, 12, 14, 17]. For 3 patients, it was the only therapeutic approach, while in the remaining case it was applied after 2 failed percutaneous attempts.…”

Section: Resultsmentioning

confidence: 99%

“…For 3 patients, it was the only therapeutic approach, while in the remaining case it was applied after 2 failed percutaneous attempts. Available data allowed to determine a 100% success rate [10, 12, 14, 17]. Bloch et al used a peculiar endoscopic-percutaneous approach [10].…”

Section: Resultsmentioning

confidence: 99%

“…Lee et al closed the fistulous orifice by placing metal clips [14]. Eventually, Curcio et al performed a circumferential clip placement along periphery of the fistula [17]. Two endoloops were placed over the endoclips and near the base, to fully close fistula [17].…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Management of duodenal stump fistula after gastrectomy for malignant disease: a systematic review of the literature

Zizzo

Ugoletti²,

Manzini³

et al. 2019

BMC Surg

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Background Duodenal stump fistula (DSF) remains one of the most serious complications following subtotal or total gastrectomy, as it endangers patient’s life. DSF is related to high mortality (16–20%) and morbidity (75%) rates. DSF-related morbidity always leads to longer hospitalization times due to medical and surgical complications such as wound infections, intra-abdominal abscesses, intra-abdominal bleeding, acute pancreatitis, acute cholecystitis, severe malnutrition, fluids and electrolytes disorders, diffuse peritonitis, and pneumonia. Our systematic review aimed at improving our understanding of such surgical complication, focusing on nonsurgical and surgical DSF management in patients undergoing gastric resection for gastric cancer. Methods We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. PubMed/MEDLINE, EMBASE, Scopus, Cochrane Library and Web of Science databases were used to search all related literature. Results The 20 included articles covered an approximately 40 years-study period (1979–2017), with a total 294 patient population. DSF diagnosis occurred between the fifth and tenth postoperative day. Main DSF-related complications were sepsis, abdominal abscess, wound infection, pneumonia, and intra-abdominal bleeding. DSF treatment was divided into four categories: conservative (101 cases), endoscopic (4 cases), percutaneous (82 cases), and surgical (157 cases). Length of hospitalization was 21–39 days, ranging from 1 to 1035 days. Healing time was 19–63 days, ranging from 1 to 1035 days. DSF-related mortality rate recorded 18.7%. Conclusions DSF is a rare but potentially lethal complication after gastrectomy for gastric cancer. Early DSF diagnosis is crucial in reducing DSF-related morbidity and mortality. Conservative and/or endoscopic/percutaneous treatments is/are the first choice. However, if the patient clinical condition worsens, surgery becomes mandatory and duodenostomy appears to be the most effective surgical procedure.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Management of duodenal stump fistula after gastrectomy for malignant disease: a systematic review of the literature

Zizzo

Ugoletti²,

Manzini³

et al. 2019

BMC Surg

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“…Mild fever associated with pain in the upper right abdomen, even many days after gastrectomy, could be indicative of DSF. Nonsurgical approaches are usually preferred [4,5], in particular percutaneous procedures such as abdominal abscess drainage, transhepatic biliary drainage with [11] or without [12] an occlusion balloon, duodenostomy [13], and fistula obliteration by glue injection [14,15], or endoscopic procedures such as DSF closure by clips [16] or endoloops and glue [17]. Nevertheless, in over one third of patients one or more reoperations are necessary.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of duodenal stump fistula after elective gastrectomy for malignancy: an Italian retrospective multicenter study

et al. 2014

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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

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“…drainage of abdominal abscess [12] and glue injection to obliterate stula [13,14] ) or the endoscopic surgeries (e.g. application of clips [15] , endoloops, glue [16] , or to close the DSF). However, at least one reoperation would be necessary in more than 1 out of 3 patients.…”

Section: Discussionmentioning

confidence: 99%

Duodenal Stump Reinforcement with Purse-string Suture in Distal Gastrectomy under Laparoscope Combined with Uncut Roux-en-Y Reconstruction in Patients with Gastric Cancer

et al. 2020

Preprint

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Background: This study aimed to compare patient outcomes after laparoscopic distal gastrectomy with uncut Roux-en-Y reconstruction for gastric cancer between a group who underwent a duodenal stump reinforcement procedure and those who did not.Methods: Data from 233 patients with gastric cancer (GC) undergoing distal gastrectomy under laparoscope combined with uncut Roux-en-Y reconstruction were retrospectively investigated. Patients were divided into two groups. The non-reinforcement group (NR) underwent surgery from June 2014 to March 2015 with no reinforcement of the duodenal stump (n=54) and the reinforcement group (R) underwent surgery from April 2015 to June 2018 with reinforcement of the duodenal stump (n=179). In group R, the duodenum was divided using an endoscope-assisted linear stapler, which was reinforced by a purse-string suture along the duodenal staple line. Results: Duodenal stump leakage was observed in 2 patients from group NR (3.7%), while no duodenal stump leakage or fistula was detected in group R. In addition, no significant difference was observed in the patient characteristics between group NR and R.Conclusions: The incidence of duodenal stump leakage can be reduced by reinforcement with a purse-string suture.

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Duodenal stump fistula following Roux-en-Y gastrectomy, treated with single-balloon enteroscopy using the tulip bundle technique and fibrin glue injection

Abstract: Duodenal stump fistula following Roux-en-Y gastrectomy, treated with single-balloon enteroscopy using the tulip bundle technique and fibrin glue injection

Cited by 6 publications

References 5 publications

Management of duodenal stump fistula after gastrectomy for malignant disease: a systematic review of the literature

Management of duodenal stump fistula after gastrectomy for malignant disease: a systematic review of the literature

Surgical management of duodenal stump fistula after elective gastrectomy for malignancy: an Italian retrospective multicenter study

Duodenal Stump Reinforcement with Purse-string Suture in Distal Gastrectomy under Laparoscope Combined with Uncut Roux-en-Y Reconstruction in Patients with Gastric Cancer

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