Management of duodenal stump fistula after gastrectomy for malignant disease: a systematic review of the literature.
Duodenal stump
Fistula
Gastrectomy
Gastric cancer
Management
Treatment
Journal
BMC surgery
ISSN: 1471-2482
Titre abrégé: BMC Surg
Pays: England
ID NLM: 100968567
Informations de publication
Date de publication:
28 May 2019
28 May 2019
Historique:
received:
28
02
2019
accepted:
21
05
2019
entrez:
30
5
2019
pubmed:
30
5
2019
medline:
30
7
2019
Statut:
epublish
Résumé
Duodenal stump fistula (DSF) remains one of the most serious complications following subtotal or total gastrectomy, as it endangers patient's life. DSF is related to high mortality (16-20%) and morbidity (75%) rates. DSF-related morbidity always leads to longer hospitalization times due to medical and surgical complications such as wound infections, intra-abdominal abscesses, intra-abdominal bleeding, acute pancreatitis, acute cholecystitis, severe malnutrition, fluids and electrolytes disorders, diffuse peritonitis, and pneumonia. Our systematic review aimed at improving our understanding of such surgical complication, focusing on nonsurgical and surgical DSF management in patients undergoing gastric resection for gastric cancer. We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. PubMed/MEDLINE, EMBASE, Scopus, Cochrane Library and Web of Science databases were used to search all related literature. The 20 included articles covered an approximately 40 years-study period (1979-2017), with a total 294 patient population. DSF diagnosis occurred between the fifth and tenth postoperative day. Main DSF-related complications were sepsis, abdominal abscess, wound infection, pneumonia, and intra-abdominal bleeding. DSF treatment was divided into four categories: conservative (101 cases), endoscopic (4 cases), percutaneous (82 cases), and surgical (157 cases). Length of hospitalization was 21-39 days, ranging from 1 to 1035 days. Healing time was 19-63 days, ranging from 1 to 1035 days. DSF-related mortality rate recorded 18.7%. DSF is a rare but potentially lethal complication after gastrectomy for gastric cancer. Early DSF diagnosis is crucial in reducing DSF-related morbidity and mortality. Conservative and/or endoscopic/percutaneous treatments is/are the first choice. However, if the patient clinical condition worsens, surgery becomes mandatory and duodenostomy appears to be the most effective surgical procedure.
Sections du résumé
BACKGROUND
BACKGROUND
Duodenal stump fistula (DSF) remains one of the most serious complications following subtotal or total gastrectomy, as it endangers patient's life. DSF is related to high mortality (16-20%) and morbidity (75%) rates. DSF-related morbidity always leads to longer hospitalization times due to medical and surgical complications such as wound infections, intra-abdominal abscesses, intra-abdominal bleeding, acute pancreatitis, acute cholecystitis, severe malnutrition, fluids and electrolytes disorders, diffuse peritonitis, and pneumonia. Our systematic review aimed at improving our understanding of such surgical complication, focusing on nonsurgical and surgical DSF management in patients undergoing gastric resection for gastric cancer.
METHODS
METHODS
We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. PubMed/MEDLINE, EMBASE, Scopus, Cochrane Library and Web of Science databases were used to search all related literature.
RESULTS
RESULTS
The 20 included articles covered an approximately 40 years-study period (1979-2017), with a total 294 patient population. DSF diagnosis occurred between the fifth and tenth postoperative day. Main DSF-related complications were sepsis, abdominal abscess, wound infection, pneumonia, and intra-abdominal bleeding. DSF treatment was divided into four categories: conservative (101 cases), endoscopic (4 cases), percutaneous (82 cases), and surgical (157 cases). Length of hospitalization was 21-39 days, ranging from 1 to 1035 days. Healing time was 19-63 days, ranging from 1 to 1035 days. DSF-related mortality rate recorded 18.7%.
CONCLUSIONS
CONCLUSIONS
DSF is a rare but potentially lethal complication after gastrectomy for gastric cancer. Early DSF diagnosis is crucial in reducing DSF-related morbidity and mortality. Conservative and/or endoscopic/percutaneous treatments is/are the first choice. However, if the patient clinical condition worsens, surgery becomes mandatory and duodenostomy appears to be the most effective surgical procedure.
Identifiants
pubmed: 31138190
doi: 10.1186/s12893-019-0520-x
pii: 10.1186/s12893-019-0520-x
pmc: PMC6540539
doi:
Types de publication
Journal Article
Systematic Review
Langues
eng
Pagination
55Commentaires et corrections
Type : ErratumIn
Références
Endoscopy. 2000 Apr;32(4):311-3
pubmed: 10774971
Clin Nutr. 2006 Apr;25(2):224-44
pubmed: 16698152
J Gastrointest Surg. 2009 Feb;13(2):239-45
pubmed: 18850251
J Surg Oncol. 2009 Jul 1;100(1):80-1
pubmed: 19373865
Clin Nutr. 2009 Aug;28(4):378-86
pubmed: 19464088
PLoS Med. 2009 Jul 21;6(7):e1000097
pubmed: 19621072
J Gastrointest Surg. 2010 May;14(5):805-11
pubmed: 20143272
Chin Med J (Engl). 2011 Apr;124(7):1018-21
pubmed: 21542961
J Gastrointest Surg. 2011 Nov;15(11):1977-81
pubmed: 21913043
Endoscopy. 2012;44 Suppl 2 UCTN:E364-5
pubmed: 23012024
Cardiovasc Intervent Radiol. 2013 Oct;36(5):1344-9
pubmed: 23483281
Case Rep Surg. 2013;2013:430295
pubmed: 24159410
Gastric Cancer. 2014 Oct;17(4):733-44
pubmed: 24399492
Hepatogastroenterology. 2014 Jul-Aug;61(133):1446-53
pubmed: 25436323
Int J Surg Case Rep. 2014;5(12):1229-33
pubmed: 25437683
Gastric Cancer. 2016 Jan;19(1):273-9
pubmed: 25491774
Rev Esp Enferm Dig. 2016 Jan;108(1):20-6
pubmed: 26765231
Eur J Trauma Emerg Surg. 2011 Jun;37(3):227
pubmed: 26815104
Ann Surg Treat Res. 2016 Mar;90(3):157-63
pubmed: 26942159
J Gastric Cancer. 2016 Mar;16(1):28-33
pubmed: 27104024
Gastric Cancer. 2017 Jan;20(1):1-19
pubmed: 27342689
Chirurgia (Bucur). 2016 Sept-Oct;111(5):400-406
pubmed: 27819638
Surg Endosc. 1989;3(3):167-9
pubmed: 2814780
Clin Nutr. 2017 Jun;36(3):623-650
pubmed: 28385477
J Gastric Cancer. 2017 Dec;17(4):354-362
pubmed: 29302375
Int J Surg. 2018 May;53:366-370
pubmed: 29653246
Expert Rev Anticancer Ther. 2018 Nov;18(11):1145-1157
pubmed: 30187785
World J Surg Oncol. 2019 Apr 15;17(1):68
pubmed: 30987645
Dig Dis Sci. 1988 Jan;33(1):30-5
pubmed: 3123177
World J Surg. 1997 Sep;21(7):763-6; discussion 767
pubmed: 9276708