Gastrojejunoduodenostomy in Prophylaxis and Treatment of Duodenal Stump Leakage after Previous Distal Gastrectomy Due to Peptic Ulcer

Abstract 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.

Download Full-text

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

10.21203/rs.3.rs-49253/v1 ◽

2020 ◽

Author(s):

Fengyuan Li ◽

Jianghao Xu ◽

Hao Xu ◽

Weizhi Wang ◽

Caidian Zhang ◽

...

Keyword(s):

Gastric Cancer ◽

Patient Outcomes ◽

Distal Gastrectomy ◽

Patient Characteristics ◽

Linear Stapler ◽

Duodenal Stump ◽

Purse String Suture ◽

Purse String ◽

Significant Difference ◽

Duodenal Stump Leakage

Abstract Objective: 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.

Download Full-text

Role of Percutaneous Transhepatic Biliary Drainage in Patients With Complications After Gastrectomy

International Surgery ◽

10.9738/intsurg-d-15-00117.1 ◽

2016 ◽

Vol 101 (1-2) ◽

pp. 78-83 ◽

Cited By ~ 2

Author(s):

Ki-Han Kim ◽

Ho-Byoung Lee ◽

Sung-Heun Kim ◽

Min-Chan Kim ◽

Ghap-Joong Jung

Keyword(s):

Biliary Drainage ◽

Percutaneous Transhepatic Biliary Drainage ◽

Duodenal Stump ◽

Surgical Interventions ◽

Afferent Loop Syndrome ◽

Soft Diet ◽

Bile Drainage ◽

Duodenal Stump Leakage ◽

Transhepatic Biliary Drainage

The aim of this study was to elucidate the role of percutaneous transhepatic biliary drainage (PTBD) in patients with duodenal stump leakage (DSL) and afference loop syndrome (ALS) postgastrectomy for malignancy or benign ulcer perforation. Percutaneous transhepatic biliary drainage (PTBD) is an interventional radiologic procedure used to promote bile drainage. Duodenal stump leakage (DSL) and afferent loop syndrome (ALS) can be serious complications after gastrectomy. From January 2002 through December 2014, we retrospectively reviewed 19 patients who underwent PTBD secondary to DSL and ALS postgastrectomy. In this study, a PTBD tube was placed in the proximal duodenum near the stump or distal duodenum in order to decompress and drain bile and pancreatic fluids. Nine patients with DSL and 10 patients with ALS underwent PTBD. The mean hospital stay was 34.3 days (range, 12 to 71) in DSL group and 16.4 days (range, 6 to 48) in ALS group after PTBD. A liquid or soft diet was started within 2.6 days (range, 1 to 7) in the ALS group and within 3.4 days (range, 0 to 15) in the DSL group after PTBD. One patient with DSL had PTBD changed, and 2 patients with ALS underwent additional surgical interventions after PTBD. The PTBD procedure, during which the tube was inserted into the duodenum, was well-suited for decompression of the duodenum as well as for drainage of bile and pancreatic fluids. This procedure can be an alternative treatment for cases of DSL and ALS postgastrectomy.

Download Full-text

A gastric stump cancer with unusual appearance

Journal of Health Sciences ◽

10.17532/jhsci.2016.289 ◽

2015 ◽

Vol 5 (3) ◽

pp. 104-106

Author(s):

Ferdane Sapmaz ◽

Sebahat Basyigit ◽

Metin Uzman ◽

Gulcin Guler Simsek ◽

Tolga Akkan ◽

...

Keyword(s):

Peptic Ulcer ◽

Abdominal Pain ◽

Classification System ◽

Distal Gastrectomy ◽

Gastric Stump ◽

Billroth Ii ◽

Poorly Differentiated Adenocarcinoma ◽

Chief Complaints ◽

Poorly Differentiated ◽

Unusual Appearance

A 60 year old man was referred to our hospital with the chief complaints of abdominal pain and vomiting. He underwent a distal gastrectomy with a Billroth II gastrojejunostomy for a peptic ulcer 13 years ago. Esophagogastroduodenoscopy (EGD) did not reveal any gross lesion in the stomach but depigmented areas were seen in the anastomosis line. The histopathology of the anastomotic area revealed poorly differentiated adenocarcinoma. Gastric stump cancers can be polypoid, fungating, ulcerated and diffusely infiltrating tumors respectively. In our case, the appearance of adenocarcinoma was quite different from that described in the classification system.

Download Full-text