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Outcomes of Non-Operative Treatment for Duodenal Stump Leakage after Gastrectomy in Patients with Gastric Cancer.

Ali BI, Park CH, Song KY - J Gastric Cancer (2016)

Bottom Line: The patients' clinical outcomes were analyzed.All 3 management modalities were successful; none of the patients needed further operative intervention.This management modality can help obviate the need for surgical intervention.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT

Purpose: We evaluated the clinical outcomes of the non-operative management of post-gastrectomy duodenal stump leakage in patients with gastric cancer.

Materials and methods: A total of 1,230 patients underwent gastrectomy at our institution between 2010 and 2014. Duodenal stump leakage was diagnosed in 19 patients (1.5%), and these patients were included in this study. The management options varied with patient condition; patients were managed conservatively, with a pigtail catheter drain, or by tube duodenostomy via a Foley catheter. The patients' clinical outcomes were analyzed.

Results: Duodenal stump leakage was diagnosed in all 19 patients within a median of 10 days (range, 1~20 days). The conservative group comprised of 5 patients (26.3%), the pigtail catheter group of 11 patients (57.9%), and the Foley catheter group of 3 patients (15.8%). All 3 management modalities were successful; none of the patients needed further operative intervention. The median hospital stay was 18, 33, and 42 days, respectively.

Conclusions: Non-operative management of duodenal stump leakage for selected groups of patients with gastric cancer was effective for control of intra-abdominal sepsis. This management modality can help obviate the need for surgical intervention.

No MeSH data available.


Related in: MedlinePlus

Foley catheter insertion into duodenal lumen via fistula tract.
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Figure 3: Foley catheter insertion into duodenal lumen via fistula tract.

Mentions: In cases requiring a duodenostomy tube, a Foley catheter was inserted to close the fistula tract. Specifically, with the patient in the supine position, a 0.035-inch guidewire was inserted, and the pigtail catheter was removed under fluoroscopic guidance. The duodenal stump opening was probed using various types of 5F angiographic catheters, and the guidewire and catheter were inserted into the duodenal lumen via the fistula tract (Fig. 3). Finally, a Foley catheter (size range, 8~16 French) was inserted. The catheter was affixed to the skin by application of mild tension. The Foley catheter was subsequently clamped if discharge decreased for more than 2 days. If the fluid accumulation was observed to decrease on follow-up CT, and if no new symptoms or pericatheter leakage was present, the Foley catheter was removed.


Outcomes of Non-Operative Treatment for Duodenal Stump Leakage after Gastrectomy in Patients with Gastric Cancer.

Ali BI, Park CH, Song KY - J Gastric Cancer (2016)

Foley catheter insertion into duodenal lumen via fistula tract.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834618&req=5

Figure 3: Foley catheter insertion into duodenal lumen via fistula tract.
Mentions: In cases requiring a duodenostomy tube, a Foley catheter was inserted to close the fistula tract. Specifically, with the patient in the supine position, a 0.035-inch guidewire was inserted, and the pigtail catheter was removed under fluoroscopic guidance. The duodenal stump opening was probed using various types of 5F angiographic catheters, and the guidewire and catheter were inserted into the duodenal lumen via the fistula tract (Fig. 3). Finally, a Foley catheter (size range, 8~16 French) was inserted. The catheter was affixed to the skin by application of mild tension. The Foley catheter was subsequently clamped if discharge decreased for more than 2 days. If the fluid accumulation was observed to decrease on follow-up CT, and if no new symptoms or pericatheter leakage was present, the Foley catheter was removed.

Bottom Line: The patients' clinical outcomes were analyzed.All 3 management modalities were successful; none of the patients needed further operative intervention.This management modality can help obviate the need for surgical intervention.

View Article: PubMed Central - PubMed

Affiliation: Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

ABSTRACT

Purpose: We evaluated the clinical outcomes of the non-operative management of post-gastrectomy duodenal stump leakage in patients with gastric cancer.

Materials and methods: A total of 1,230 patients underwent gastrectomy at our institution between 2010 and 2014. Duodenal stump leakage was diagnosed in 19 patients (1.5%), and these patients were included in this study. The management options varied with patient condition; patients were managed conservatively, with a pigtail catheter drain, or by tube duodenostomy via a Foley catheter. The patients' clinical outcomes were analyzed.

Results: Duodenal stump leakage was diagnosed in all 19 patients within a median of 10 days (range, 1~20 days). The conservative group comprised of 5 patients (26.3%), the pigtail catheter group of 11 patients (57.9%), and the Foley catheter group of 3 patients (15.8%). All 3 management modalities were successful; none of the patients needed further operative intervention. The median hospital stay was 18, 33, and 42 days, respectively.

Conclusions: Non-operative management of duodenal stump leakage for selected groups of patients with gastric cancer was effective for control of intra-abdominal sepsis. This management modality can help obviate the need for surgical intervention.

No MeSH data available.


Related in: MedlinePlus