Surgical and nutritional management of postoperative duodenal fistulas

Garden, O. James; Dykes, Evelyn H.; Carter, D C

doi:10.1007/bf01536627

Cited by 25 publications

(39 citation statements)

References 14 publications

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“…According to those data, DSF incidence was about 3 %, overall mortality ranges from 7 to 67 % [2,23,24], and spontaneous fistula closure ranges from 28 to 92 % [18,23,25].…”

Section: Discussionmentioning

confidence: 99%

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Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience

et al. 2014

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Background Duodenal stump fistula (DSF) is the most severe surgical complication after gastrectomy. This study was designed to assess the incidence, to observe the consequences, and to identify the risk factors associated with DSF after gastrectomy. Methods All procedures involving total or sub-total gastrectomy for cancer, performed between January 1987 and June 2012 in a single institution, were prospectively entered into a computerized database. Risk factors analysis was performed between DSF patients, patients with complete uneventful postoperative course and patients with other major surgical complications. Results Over this 25 years period, 1287 gastrectomies were performed. DSF was present in 32 cases (2.5 %). Mean post-operative onset was 6.6 days. 19 patients were treated conservatively and 13 surgically. Mean DSF healing time was 31.2 and 45.2 days in the two groups, respectively. Mortality was registered in 3 cases (9.37 %), due to septic shock (2 cases) and bleeding (1 case). In monovariate analysis, heart disease (p \ 0.001), pre-operative lymphocytes number (p = 0.003) and absence of manual reinforcement over duodenal stump (p \ 0.001) were found to be DSF-specific risk factors, whereas liver cirrhosis (p = 0.002), pre-operative albumin levels (p \ 0.001) and blood losses (p = 0.002) were found to be non-DSF-specific risk factors. In multivariate analysis heart disease (OR 5.18; p \ 0.001), liver cirrhosis (OR 13.2; p \ 0.001), bio-humoral nutritional status impairment (OR 2.29; p = 0.05), blood losses [300 mL (OR 4.47; p = 0.001) and absence of manual reinforcement over duodenal stump (OR 30.47; p \ 0.001) were found to be independent risk factors for DSF development. Conclusions Duodenal stump fistula still remains a lifethreatening complication after gastric surgery. Co-morbidity factors, nutritional status impairment and surgical technical difficulties should be considered as important risk factors in developing this awful complication.

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“…According to those data, DSF incidence was about 3 %, overall mortality ranges from 7 to 67 % [2,23,24], and spontaneous fistula closure ranges from 28 to 92 % [18,23,25].…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, administration of enteral and/or total parenteral nutrition according to nutritional guide-lines [14,15], allows a faster fistula healing and a lower morbidity rate [16][17][18][19]. Finally, the use of somatostatin and its analogues are proved to reduce fistula output and to shorten healing times [20,21].…”

Section: Introductionmentioning

confidence: 99%

Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience

et al. 2014

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“…Total protein was 6.28 g/dl (range, 5.2-7 g/dl), located at the normal lower limit (6-8.3 g/dl). The average preoperative total lymphocyte count was 1,572.2/mm 3 (range, 530-3,630/ mm 3 ), also in the normal lower limit (1,500-4,000/mm 3 ). Clinical symptoms of DSF in the conservative treatment group were abdominal pain (3 patients) and bilious-enteric drainage (2 patients); surgical patients had one of the following: hypovolemic or septic shock with or without acute abdomen (7 patients) and bilious drainage output material (in 1 patient).…”

Section: Resultsmentioning

confidence: 89%

“…Despite its low inci-dence (around 3%), its importance lies in its association with a high morbidity and mortality (overall mortality ranges from 7-67%) and variable spontaneous cure rates (between 28-92% of cases) (2,3,7,8).…”

Section: Discussionmentioning

confidence: 99%

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Duodenal fistula after gastrectomy: Retrospective study of 13 new cases

Cornejo¹,

Priego²,

Ramos³

et al. 2015

Rev Esp Enferm Dig

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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.

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Nutrition and management of enterocutaneous fistula

Lloyd

Gabe

Windsor

2006

British Journal of Surgery

181

202

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Management of enterocutaneous fistula should initially concentrate on correction of fluid and electrolyte imbalances, drainage of collections, treatment of sepsis and control of fistula output. The routine use of somatostatin infusion and somatostatin analogues remains controversial; although there are data suggesting reduced time to fistula closure, there is little evidence of increased probability of spontaneous closure. Malnutrition is common and adequate nutritional provision is essential, enteral where possible, although supplemental parenteral nutrition is often required for high-output small bowel fistulas. The role of immunonutrition is unknown. Surgical repair should be attempted when spontaneous fistula closure does not occur, but it should be delayed for at least 3 months.

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Surgical and nutritional management of postoperative duodenal fistulas

Cited by 25 publications

References 14 publications

Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience

Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single centre experience

Duodenal fistula after gastrectomy: Retrospective study of 13 new cases

Nutrition and management of enterocutaneous fistula

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