Management of the Difficult Duodenal Stump

Colonic seromuscular augmentation cystoplasty following subtotal cystectomy for treatment of bladder necrosis caused by bladder torsion in a dog

“…The extensive vascularity of the omentum can provide blood supply through its angiogenic, immunogenic, and adhesive properties, but it lacks the holding strength of seromuscular tissue. 3,4 A seromuscular patch was used in the dog of this report because such patches readily form adhesions, have a good blood supply, and provide tensile strength. 5 We did not pursue primary closure of the urinary bladder because of partial-thickness necrosis of the bladder wall and associated risk of dehiscence.…”

A Life‐saving but Inadequately Discussed Procedure: Tube Duodenostomy. Known and Unknown Aspects

“…Duodenal stump closure carries a leak rate of 1%–3 % in collected series [1–6]. The mortality rate from this complication is distressingly as high as 50% in early reviews [1–5, 7, 8]. Although advances in supportive care have reduced the mortality rates to 0%–12 % in recent studies [6, 9, 10], duodenal stump leakage still remains one of the most feared complications of gastric resection.…”

A safer and simpler technique of duodenal dissection and transection of the duodenal bulb for duodenal switch

“…In the past, papers have reported duodenal leak rates after DS of 1.5% [3,5]. We believe this occurs when there are injuries to the supraduodenal artery and vein or the superior pancreaticoduodenal artery and vein, leading to ischemia [1,6]. These injuries can be avoided using our technique, preserving the blood supply to the duodenal stump.…”

“…One common reasons that many surgeons do not perform a duodenal switch (DS) is lack of experience with the dissection over the head of the pancreas [1]. We have developed a more tolerable and simpler technique for this dissection that allows any surgeon who has the skills to perform a gastric bypass to perform this dissection easily.…”