Management of Duodenal Fistulas in Gastric Surgery
Summary
Duodenal fistulas represent a formidable complication of gastric surgery, often arising after gastrectomy and reconstruction procedures. The continuous leakage of biliary and pancreatic secretions leads to local tissue erosion, sepsis and nutritional deficits. Management strategies balance prompt control of contamination, restoration of digestive continuity and optimisation of patient physiology. Initial assessment focuses on fistula output, anatomical location and the presence of sepsis or peritonitis. High-output fistulas generally necessitate surgical intervention with duodenal decompression and reinforcement or re-anastomosis, while low-output leaks may be amenable to non-operative approaches including percutaneous drainage, nutritional support and pharmacological suppression of secretions. Advances in laparoscopic reinforcement techniques, innovative drainage methods and endoscopic decompression have broadened the therapeutic armamentarium. Multidisciplinary care, incorporating intensive nutritional management and organ support, remains central to improving closure rates and reducing mortality.
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Management of Duodenal Fistulas in Gastric Surgery publication trend
The graph below shows the total number of articles in management of duodenal fistulas in gastric surgery across all publications each year (not limited to Nature Index journals).
Technical terms
Duodenal fistula: An abnormal channel allowing leakage of duodenal contents into surrounding tissues or externally.
Duodenal stump leakage: Failure of closure at the transected duodenal end following gastrectomy, leading to external or internal leakage.
Purse-string suture: A circular stitch placed around an opening to draw tissue edges together upon tightening.
Q-type embedding method: A modified purse-string technique designed to reinforce the duodenal stump by embedding suture loops in a specific geometric configuration.
Double-balloon endoscopy: An advanced endoscopic method employing two balloons to navigate and stabilise long segments of small intestine for intervention.
References
- Complex duodenal fistulae: a surgical nightmare. World Journal of Emergency Surgery (2023).
- Modified Q-type purse-string suture duodenal stump embedding method for laparoscopic gastrectomy for gastric cancer. BMC Surgery (2024).
- Retrograde drainage for duodenal stump leakage using ileal decompression tube guided by double-balloon endoscopy: a novel case report. Surgical Case Reports (2024).
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