Year 2016 / Volume 108 / Number 1
Original
Duodenal fistula after gastrectomy: Retrospective study of 13 new cases

20-26

DOI: 10.17235/reed.2015.3928/2015

Mª Ángeles Cornejo, Pablo Priego, Diego Ramos, Magdalena Coll, Araceli Ballestero, Julio Galindo, Francisca García-Moreno, Gloria Rodríguez, Pedro Carda, Eduardo Lobo,

Abstract
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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Cornejo M, Priego P, Ramos D, Coll M, Ballestero A, Galindo J, et all. Duodenal fistula after gastrectomy: Retrospective study of 13 new cases . 3928/2015


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Publication history

Received: 15/07/2015

Accepted: 02/09/2015

Online First: 04/12/2015

Published: 30/12/2015

Article revision time: 40 days

Article Online First time: 142 days

Article editing time: 168 days


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