The use of catheter duodenostomy in gastric resection for duodenal ulcer

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

“…The most successful method of managing the difficult duodenum has been the TD technique. But published series about TD had either few patients or insufficient information related to indication, technique, and postoperative care [11][12][13][14][15][16][17][18][19][20]. We think a leak rate of 33% after TD in the study by Burch et al [6] was disappointing and surprising.…”

“…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. The most successful method of managing the difficult duodenum has been the tube duodenostomy (TD) technique, which has been effectively used and reported by many surgeons [11][12][13][14][15][16][17][18][19][20]. It is surprising that, despite the good results reported with this technique [11][12][13][14][18][19][20], it has not gained wide acceptance and is rarely used.…”

“…The most successful method of managing the difficult duodenum has been the tube duodenostomy (TD) technique, which has been effectively used and reported by many surgeons [11][12][13][14][15][16][17][18][19][20]. It is surprising that, despite the good results reported with this technique [11][12][13][14][18][19][20], it has not gained wide acceptance and is rarely used. Tube duodenostomy has been generally used when surgical closure of the inflamed or scarred duodenum from chronic ulcer is not safe in gastric resections done for peptic ulcer or when a duodenal stump leakage has occurred after duodenal closure in any operation.…”

T-tube Duodenostomy for the Difficult Duodenum

“…They reported a total stump leak rate of 7.7% and showed a significant increase in the duodenal stump leakage rate of 21% compared to the 3.4% in the elective group [8]. It has been shown that the management of the duodenum in these high-risk scenarios is feasible and safe by using a duodenostomy tube for decompression and drainage [2][3][4][5][6][7].…”

“…However, primary closure of the duodenal stump can be arduous in many cases due to the presenting anatomic pathology. In such cases, the use of tube duodenostomy has been described as a useful technique in the management of a variety of duodenal pathologies [2][3][4][5][6][7]. Many cases have reported the use of a Malecot catheter as a duodenostomy tube [3].…”