Ann Surg Treat Res.  2016 Mar;90(3):157-163. 10.4174/astr.2016.90.3.157.

Duodenal stump fistula after gastrectomy for gastric cancer: risk factors, prevention, and management

• Paik HJ
• Lee SH
• Choi CI
• Kim DH
• Jeon TY
• Kim DH
• Jeon UB
• Choi CW
• Hwang SH

• KMID: 2155049
• DOI: http://doi.org/10.4174/astr.2016.90.3.157

Abstract

PURPOSE
A duodenal stump fistula is one of the most severe complications after gastrectomy for gastric cancer. We aimed to analyze the risk factors for this problem, and to identify the methods used for its prevention and management.
METHODS
We retrospectively reviewed the clinical data of 716 consecutive patients who underwent curative gastrectomy with a duodenal stump for gastric cancer between 2008 and 2013.
RESULTS
A duodenal stump fistula occurred in 16 patients (2.2%) and there were 2 deaths in this group. Univariate analysis revealed age >60 years (odds ratio [OR], 3.09; 95% confidence interval [CI], 0.99-9.66), multiple comorbidities (OR, 4.23; 95% CI, 1.50-11.92), clinical T stage (OR, 2.91; 95% CI, 1.045-8.10), and gastric outlet obstruction (OR, 8.64; 95% CI, 2.61-28.61) to be significant factors for developing a duodenal stump fistula. Multivariate analysis identified multiple comorbidities (OR, 3.92; 95% CI, 1.30-11.80) and gastric outlet obstruction (OR, 5.62; 95% CI, 1.45-21.71) as predictors of this complication.
CONCLUSION
Multiple comorbidities and gastric outlet obstruction were the main risk factors for a duodenal stump fistula. Therefore, preventive methods and aggressive management should be applied for patients at high risk.

Keyword

Intestinal fistula; Gastric neoplasms; Gastrectomy; Complication

MeSH Terms

Comorbidity
Fistula*
Gastrectomy*
Gastric Outlet Obstruction
Humans
Intestinal Fistula
Multivariate Analysis
Retrospective Studies
Risk Factors*
Stomach Neoplasms*

Figure

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  Fig. 1 Flow chart of identified risk factors for duodenal stump fistula after gastrectomy. GOO, gastric outlet obstruction.

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  Fig. 2 Methods used to prevent duodenal stump fistula in our institution. (A) Fibrin sealant being applied to the duodenal stump. (B) Absorbable reinforcement felt used to seal over the duodenal stump.

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  Fig. 3 Ultrasound-guided percutaneous transhepatic biliary drainage (PTBD) was used to divert bile from the duodenal stump. Right PTBD was done via B6 (segmental bile duct from segment 6 of liver) with an 8.5-F pigtail catheter.

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