DUODENAL STUMP LEAKAGE
Abstract
Background. Duodenal stump leakage (DSL) is a serious complication after gastric resections and gastrectomy with an incidence of 4% to 11% and mortality rates ranging from 10% to 18.7%. Objective. To systematize modern scientific data on the etiopathogenesis, diagnostic methods and modern approaches to the treatment of duodenal stump leakage. Material and Methods. A review of current scientific articles on duodenal leakage was conducted, including those found in PubMed, ScienceDirect, eLibrary, and Google Scholar. Results. The causes of this complication were found to include both local and systemic factors. Clinical manifestations of duodenal stump leakage typically occur on days 6–9. The gold standard for diagnosis is contrast-enhanced computed tomography (CECT). Conservative therapy consists of drainage, antibiotic therapy, and nutritional support. Minimally invasive methods are currently preferred. Open surgery is indicated in cases when peritonitis develops and minimally invasive methods turn out to be ineffective. Conclusion. The lack of a single, standardized approach demonstrates the need for further research aimed at eliminating the causes and developing clinical guidelines.
References
Ramos MFKP, Pereira MA, Barchi LC, Yagi OK, Dias AR, Szor DJ, Zilberstein B, Ribeiro-Júnior U, Cecconello I. Duodenal fistula: The most lethal surgical complication in a case series of radical gastrectomy. Int J Surg. 2018;53:366-370. https://doi.org/10.1016/j.ijsu.2018.03.082.
Babu BI, Finch JG. Current status in the multidisciplinary management of duodenal fistula. Surgeon. 2013;11(3):158-64. https://doi.org/10.1016/j.surge.2012.12.006.
Po Chu Patricia Y, Ka Fai Kevin W, Fong Yee L, Kiu Jing F, Kylie S, Siu Kee L. Duodenal stump leakage. Lessons to learn from a large-scale 15-year cohort study. Am J Surg. 2020;220(4):976-981. https://doi.org/10.1016/j.amjsurg.2020.02.042.
Krasilnikov DM, Minnullin MM, Nikolaev YaU. Diagnostika i kompleksnoe lechenie nesostojatelnosti shvov zheludochno-kishechnogo trakta u bolnyh jazvennoj boleznju zheludka i dvenadcatiperstnoj kishki [Diagnosis and complex treatment of seams lack of the gastrointestinal tract of patients with gastric ulcer and duodenal ulcer]. Kreativnaja hirurgija i onkologija [Creative surgery and oncology]. 2012;(3):49-55. https://doi.org/10.24060/2076-3093-2012-0-3-49-55. https://www.elibrary.ru/zrbuwt. (Russian).
Cozzaglio L, Coladonato M, Biffi R, Coniglio A, Corso V, Dionigi P, Gianotti L, Mazzaferro V, Morgagni P, Rosa F, Rosati R, Roviello F, Doci R. Duodenal fistula after elective gastrectomy for malignant disease: an Italian retrospective multicenter study. J Gastrointest Surg. 2010;14(5):805-811. https://doi.org/10.1007/s11605-010-1166-2.
Tomnjuk ND, Rjabkov IA, Danilina EP, Hovalyg BC, Zdzitovetskij DJe, Kembel VR, Borisov RN. Prichiny nesostojatelnosti shvov kulti dvenadcatiperstnoj kishki posle rezekcii zheludka po bilrot II [Cause suture failure cults duodenal after stomach resection billroth II, their diagnosis, treatment, prevention]. Mezhdunarodnyj zhurnal prikladnyh i fundamentalnyh issledovanij. 2016;6-1:74-77. (Russian).
Cozzaglio L, Giovenzana M, Biffi R, Cobianchi L, Coniglio A, Framarini M, Gerard L, Gianotti L, Marchet A, Mazzaferro V, Morgagni P, Orsenigo E, Rausei S, Romano F, Rosa F, Rosati R, Roviello F, Sacchi M, Morenghi E, Quagliuolo V. Surgical management of duodenal stump fistula after elective gastrectomy for malignancy: an Italian retrospective multicenter study. Gastric Cancer. 2016;19(1):273-279. https://doi.org/10.1007/s10120-014-0445-0.
Ali BI, Park CH, Song KY. Outcomes of Non-Operative Treatment for Duodenal Stump Leakage after Gastrectomy in Patients with Gastric Cancer. J Gastric Cancer. 2016;16(1):28-33. https://doi.org/10.5230/jgc.2016.16.1.28.
Krasilnikov DM, Fedorov VV, Hajrullin II. Hirurgicheskoe lechenie bolnyh jazvennoj boleznju zheludka i dvenadcatiperstnoj kishki. Kazan; 1998. 34 p. (Russian).
Pisarevskiĭ GN. Metody ushivaniya kulti dvenadtsatiperstnoy kishki [Мethods of the duodenal stump closure]. Hirurgija. Zhurnal im. N.I. Pirogova [Pirogov Russian Journal of Surgery]. 2011;(3):67 72. edn: NZGHGH. (Russian).
Vancjan JeN. Naruzhnye i vnutrennie svishhi v hirurgicheskoj klinike. Moskva: Medicina; 1990. 224 p. (Russian).
Cooper P, Pecora DV. The problem of duodenal closure after gastrectomy for duodenal ulcer. Am J Surg. 1956;91(2):231-233. https://doi.org/10.1016/0002-9610(56)90418-4.
Kotomina SI. K metodike atipichnogo ukrytija kulti dvenadcatiperstnoj kishki pri rezekcii zheludka. Uchenye zapiski Gorkovskogo medicinskogo gosudarstvennogo instituta im. S.M. Kirova. 1958;6:179-182. (Russian).
Monteiro A. Management of the duodenal stump in operation for penetrating ulcer. J lnt Coll Surg. 1950;13(5):489-496.
Senchillo ZT. K voprosu o zakrytii kulti dvenadcatiperstnoj kishki dvumja sposobami Sapozhkova. In: Sbornik nauchyh rabot, posvjashhennyj 50-letiju dejatelnosti prof. K.P. Sapozhkova. Irkutsk; 1953. р. 69-86. (Russian).
Petrov VP, Romanenko FG. Hirurgicheskaja taktika pri nesostojatelnosti shvov posle rezekcii i jekstirpacii zheludka. Hirurgija. Zhurnal im. N.I. Pirogova [Pirogov Russian Journal of Surgery]. 1983;59(2):67-69. (Russian).
Jeong SH, Lee JK, Seo KW, Min JS. Treatment and Prevention of Postoperative Leakage after Gastrectomy for Gastric Cancer. J Clin Med. 2023;12(12):3880. https://doi.org/10.3390/jcm12123880.
Migita K, Takayama T, Matsumoto S, Wakatsuki K, Enomoto K, Tanaka T, Ito M, Nakajima Y. Risk factors for esophagojejunal anastomotic leakage after elective gastrectomy for gastric cancer. J Gastrointest Surg. 2012;16(9):1659-1665. https://doi.org/10.1007/s11605-012-1932-4.
Upponi S, Ganeshan A, D'Costa H, Betts M, Maynard N, Bungay H, Slater A. Radiological detection of post-oesophagectomy anastomotic leak – A comparison between multidetector CT and fluoroscopy. Br J Radiol. 2008;81(967):545-548. https://doi.org/10.1259/bjr/30515892.
Kim TH, Kim JH, Shin CI, Kim SH, Han JK, Choi BI. CT findings suggesting anastomotic leak and predicting the recovery period following gastric surgery. Eur Radiol. 2015;25(7):1958-1966. https://doi.org/10.1007/s00330-015-3608-4.
Lamb PJ, Griffin SM, Chandrashekar MV, Richardson DL, Karat D, Hayes N. Prospective study of routine contrast radiology after total gastrectomy. Br J Surg. 2004;91(8):1015-1019. https://doi.org/10.1002/bjs.4638.
Tonouchi H, Mohri Y, Tanaka K, Ohi M, Kobayashi M, Yamakado K, Kusunoki M. Diagnostic sensitivity of contrast swallow for leakage after gastric resection. World J Surg. 2007;31(1):128-131. https://doi.org/10.1007/s00268-006-0246-7.
Jeong SH, Lee JK, Seo KW, Min JS. Treatment and Prevention of Postoperative Leakage after Gastrectomy for Gastric Cancer. J Clin Med. 2023;12(12):3880. https://doi.org/10.3390/jcm12123880.
Kähler G. Anastomotic Leakage after Upper Gastrointestinal Surgery: Endoscopic Treatment. Visc Med. 2017;33(3):202-206. https://doi.org/10.1159/000475783.
Hogan BA, Winter DC, Broe D, Broe P, Lee MJ. Prospective trial comparing contrast swallow, computed tomography and endoscopy to identify anastomotic leak following oesophagogastric surgery. Surg Endosc. 2008;22(3):767-771. https://doi.org/10.1007/s00464-007-9629-6.
Bruce J, Krukowski ZH, Al-Khairy G, Russell EM, Park KG. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg. 2001;88(9):1157-1168. https://doi.org/10.1046/j.0007-1323.2001.01829.x.
Nikitin NA. Nedostatochnost shvov duodenalnoj kulti v urgentnoj hirurgii jazvennoj bolezni. Kirov: Vjatka; 2002. 215 p. (Russian).
Cozzaglio L, Farinella E, Coladonato M, Sciannameo F, Gennari L, Doci R. Current role of surgery in the treatment of digestive fistulas. Ann Ital Chir. 2010;81(4):285-94.
Cornejo Mde L, Priego P, Ramos D, Coll M, Ballestero A, Galindo J, García-Moreno F, Rodríguez G, Carda P, Lobo E. Duodenal fistula after gastrectomy: Retrospective study of 13 new cases. Rev Esp Enferm Dig. 2016;108(1):20-26. https://doi.org/10.17235/reed.2015.3928/2015.
Ramos MFKP, Pereira MA, Barchi LC, Yagi OK, Dias AR, Szor DJ, Zilberstein B, Ribeiro-Júnior U, Cecconello I. Duodenal fistula: the most lethal surgical complication in a case series of radical gastrectomy. Int J Surg. 2018;53:366-370. https://doi.org/10.1016/j.ijsu.2018.03.082.
Orsenigo E, Bissolati M, Socci C, Chiari D, Muffatti F, Nifosi J, Staudacher C. Duodenal stump fistula after gastric surgery for malignancies: a retrospective analysis of risk factors in a single Centre experience. Gastric Cancer. 2014;17(4):733-744. https://doi.org/10.1007/s10120-013-0327-x.
Garden OJ, Dykes EH, Carter DC. Surgical and nutritional management of postoperative duodenal fistulas. Dig Dis Sci. 1988;33(1):30-35. https://doi.org/10.1007/BF01536627.
Kyzer S, Binyamini Y, Melki Y, Ohana G, Koren R, Chaimoff C, Wolloch Y. Comparative study of the early postoperative course and complications in patients undergoing Billroth I and Billroth II gastrectomy. World J Surg. 1997;21(7):763-766. https://doi.org/10.1007/s002689900302.
Cozzaglio L, Cimino M, Mauri G, Ardito A, Pedicini V, Poretti D, Brambilla G, Sacchi M, Melis A, Doci R. Percutaneous transhepatic biliary drainage and occlusion balloon in the management of duodenal stump fistula. J Gastrointest Surg. 2011;15(11):1977-1781. https://doi.org/10.1007/s11605-011-1668-6.
Kim KH, Kim MC, Jung GJ. Risk factors for duodenal stump leakage after gastrectomy for gastric cancer and management technique of stump leakage. Hepatogastroenterology. 2014;61(133):1446-1453.
Babu BI, Finch JG. Current status in the multidisciplinary management of duodenal fistula. Surgeon. 2013;11(3):158-164. https://doi.org/10.1016/j.surge.2012.12.006.
Zizzo M, Ugoletti L, Manzini L, Castro Ruiz C, Nita GE, Zanelli M, De Marco L, Besutti G, Scalzone R, Sassatelli R, Annessi V, Manenti A, Pedrazzoli C. Management of duodenal stump fistula after gastrectomy for malignant disease: a systematic review of the literature. BMC Surg. 2019;19(1):55. https://doi.org/10.1186/s12893-019-0520-x.
Oh JS, Lee HG, Chun HJ, Choi BG, Lee SH, Hahn ST, Ohm JY. Percutaneous management of postoperative duodenal stump leakage with Foley catheter. Cardiovasc Intervent Radiol. 2013;36(5):1344-1349. https://doi.org/10.1007/s00270-012-0518-6.
Cozzaglio L, Cimino M, Mauri G, Ardito A, Pedicini V, Poretti D, Brambilla G, Sacchi M, Melis A, Doci R. Percutaneous transhepatic biliary drainage and occlusion balloon in the management of duodenal stump fistula. J Gastrointest Surg. 2011;15(11):1977-1981. https://doi.org/10.1007/s11605-011-1668-6.
Villar R, Fernàndez R, Gonzàlez J, Oliver JM, Parga G, Garcìa-Hidalgo E. High-output external duodenal fistula: treatment with percutaneous transhepatic biliary/duodenal drainage. Cardiovasc Intervent Radiol. 1996;19(5):371-373. https://doi.org/10.1007/BF02570195.
Cozzaglio L, Cimino М, Mauri G, Ardito A, Pedicini V, Poretti D, Brambilla G, Sacchi M, Melis A, Doci R. Percutaneous Transhepatic Biliary Drainage and Occlusion Balloon in the Management of Duodenal Stump Fistula. Journal of Gastrointestinal Surgery. 2011;15(11):1977-1981. https://doi.org/10.1007/s11605-011-1668-6.
Lee JY, Ryu KW, Cho SJ, Kim CG, Choi IJ, Kim MJ, Lee JS, Kim HB, Lee JH, Kim YW. Endoscopic clipping of duodenal stump leakage after Billroth II gastrectomy in gastric cancer patient. J Surg Oncol. 2009;100(1):80-81. https://doi.org/10.1002/jso.21285.
Wong SK, Lam YH, Lau JY, Lee DW, Chan AC, Chung SC. Diagnostic and therapeutic fistuloscopy: an adjuvant management in postoperative fistulas and abscesses after upper gastrointestinal surgery. Endoscopy. 2000;32(4):311-313. https://doi.org/10.1055/s-2000-7378.
Curcio G, Badas R, Miraglia R, Barresi L, Tarantino I, Traina M. Duodenal stump fistula following roux-en-Y gastrectomy, treated with single-balloon enteroscopy using the tulip bundle technique and fibrin glue injection. Endoscopy. 2012;44(Suppl 2):E364-365. https://doi.org/10.1055/s-0032-1310073.
Bloch P, Gompel H. Treatment of postoperative duodenal fistulae by transparietal abdominal endoscopic intubation. Surg Endosc. 1989;3(3):167-169. https://doi.org/10.1007/BF00591365.
Wichmann D, Stüker D, Schweizer U, Senne M, Duckworth-Mothes B, Zerabruck E, Königsrainer A, Bachmann J. Endoscopic negative pressure therapy for duodenal leaks. Front Surg. 2023;10:1099457. https://doi.org/10.3389/fsurg.2023.1099457.
Kamada T, Satoh K, Itoh T, Ito M, Iwamoto J, Okimoto T, Kanno T, Sugimoto M, Chiba T, Nomura S, Mieda M, Hiraishi H, Yoshino J, Takagi A, Watanabe S, Koike K. Evidence-based clinical practice guidelines for peptic ulcer disease 2020. J Gastroenterol. 2021;56(4):303-322. https://doi.org/10.1007/s00535-021-01769-0.
Hur H, Lim YS, Jeon HM, Kim W. Management of anastomotic leakage after gastrointestinal surgery using fluoroscopy-guided Foley catheter. J Korean Surg Soc. 2010;78(3):165-170. https://doi.org/10.4174/jkss.2010.78.3.165.
Milias K, Deligiannidis N, Papavramidis TS, Ioannidis K, Xiros N, Papavramidis S. Biliogastric diversion for the management of high-output duodenal fistula: report of two cases and literature review. J Gastrointest Surg. 2009;13(2):299-303. https://doi.org/10.1007/s11605-008-0677-6.
Zizzo M, Morini A, Zanelli M, Broggi G, Sanguedolce F, Koufopoulos NI, Palicelli A, Mangone L, Fabozzi M, Giuffrida M, Bonelli C, Marchesi F. Impact of Duodenal Stump Reinforcement in Preventing Duodenal Stump Fistula/Leakage After Distal or Total Gastrectomy for Malignant Disease: A Meta-Analysis of Comparative Studies. Cancers (Basel). 2025;17(11):1735. https://doi.org/10.3390/cancers17111735.
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