Gastrojejunoduodenostomy in treatment and prophylaxis of duodenal stump leakage

Authors

  • V. I. Rusyn Uzhhorod National University
  • K. Ye. Rumiantsev Uzhhorod National University
  • V. V. Rusyn Uzhhorod National University
  • V. V. Mashura Uzhhorod National University

DOI:

https://doi.org/10.11603/2414-4533.2020.2.10762

Keywords:

виразкова хвороба дванадцятипалої кишки, резекція шлунка, кукса дванадцятипалої кишки, неспроможність кукси, гастроєюнодуоденостомія

Abstract

The aim of the work: to evaluate the effectiveness of conjunction of the duodenum with a Roux-en-Y loop of the small intestine in the prevention and treatment of the duodenal stump leakage after distal gastrectomy.

Materials and Methods. From 2009 to 2019, the authors applied a proposed method of the digestive tract continuity restoration in 15 patients.

For the first time, gastrojejunoduodenostomy was applied in patients with traumatic duodenal injury (3 patients). Later such an operation was performed in case of duodenal stump primary closure impossibility (4 patients) and in case of its leakage in the postoperative period (8 patients). One patient (12.5 %) died after surgery for duodenal stump leakage.

Results and Discussion. Evaluating the experience of gastrojejunoduodenostomy on the Roux-en-Y small intestine loop, authors have noted the following positive features: versatility – the ability to apply it both in the primary “difficult” stump closure and in its leakage treatment; technical simplicity – the surgeon only transects and creates mainly standard anastomoses without plasty, tailoring, etc.; suitability for penetrating, "low" and juxtapapillary ulcers – so sewing the small intestine to the stump is possible even over the crater of the ulcer or over the 1mm wide edge of the duodenal mucosa; suitability in absence of the anterior wall of the duodenum – after the pre-imposed gastroduodenostomy by Finney or Jaboulay, or after the excision of perforated ulcer by Judd; plastic properties – the use of a well-vascularized loop of the small intestine to close the defect of the duodenum with inflamed edges after its leakage is essentially the same as a skin flap transplantation to a wound defect on the surface of the body; decompression of the duodenum – with increasing pressure in the duodenum as a result of the accumulation of secretions, decompression due to anastomosis with the small intestine is very likely; reduodenisation of the food passage.

References

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Published

2020-01-20

How to Cite

Rusyn, V. I., Rumiantsev, K. Y., Rusyn, V. V., & Mashura, V. V. (2020). Gastrojejunoduodenostomy in treatment and prophylaxis of duodenal stump leakage. Hospital Surgery. Journal Named by L.Ya. Kovalchuk, (2), 39–45. https://doi.org/10.11603/2414-4533.2020.2.10762

Issue

No. 2 (2020)

Section

EXPERIENCE OF WORK

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