Document Detail


Management of the difficult duodenal stump.
MedLine Citation:
PMID:  1670218     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Leakage from the duodenal stump has been the most feared complication of the Billroth II reconstruction following gastric resection. The purpose of our study was to evaluate four methods of duodenal stump closure in 200 patients. One hundred and forty-seven (74%) patients had duodenal ulcers; 28 (14%) had gastric ulcers; and 25 (13%) had a variety of other inflammatory conditions. The most common indication for operation was acute hemorrhage (51%), followed by perforation (24%), intractability (15%), and obstruction (10%). Conventional duodenal closures were performed in 160 (80%) patients, Nissen's closure in 25 (13%), Bancroft's closure in 6 (3%), and tube duodenostomy in 9 (5%). Duodenal leaks occurred in four (2.5%) patients with conventional closures and in three (33%) patients with tube duodenostomies. No leaks occurred in patients with Nissen's or Bancroft's closures. The hospital mortality rate for the series was 9.5%; however, no patient who developed a duodenal leak died. We conclude that Nissen's and Bancroft's closures were safe and effective, but that tube duodenostomy did not reliably prevent uncontrolled leakage.
Authors:
J M Burch; C L Cox; D V Feliciano; R J Richardson; R R Martin
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of surgery     Volume:  162     ISSN:  0002-9610     ISO Abbreviation:  Am. J. Surg.     Publication Date:  1991 Dec 
Date Detail:
Created Date:  1994-07-14     Completed Date:  1994-07-14     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  522-6     Citation Subset:  AIM; IM    
Affiliation:
Cora and Webb Mading Department of Surgery, Baylor College of Medicine, Houston, Texas 77030.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Anastomosis, Surgical
Duodenal Ulcer / surgery
Duodenum / surgery*
Female
Gastrectomy / methods*
Humans
Jejunum / surgery*
Male
Middle Aged
Peptic Ulcer / surgery*
Postoperative Complications
Stomach / surgery*
Stomach Ulcer / surgery
Treatment Outcome
Comments/Corrections
Comment In:
Am J Surg. 1994 Apr;167(4):460   [PMID:  8179099 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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