Miniinvasive method of treatment of the duodenal sutures insufficiency
Abstract
Objective. To improve the results of treatment in patients with insufficiency of duodenal sutures.
Materials and metods. Retrospective and prospective investigation was accomplished on 17 patients, suffering insufficiency of sutures, injuries and fistulas of duodenum, who were admitted for treatment into Shalimov National Institute of Surgery and Transplantology during 2010-2020 yrs. In all the patients a complex examination, including a general clinical one, special laboratory and instrumental methods of investigation, was conducted.
Results. Miniinvasive endoscopic method for the treatment of the duodenal sutures insufficiency was elaborated with a patent obtaining, which consists of endoscopic placement of a covered nitinol self-expanding stent into the defect zone. In presence of the complication, constituting a duodenal fistula, there was proposed to place a covered nitinol self-expanding stent into the defect zone together with vacuum-therapy from the side of the fistula external aperture. Due to application of the treatment method elaborated, it have become possible to reduce the morbidities quantity and to shorten the patients’ stationary stay by 36% - from (38.1 ± 4.16) to (25.4 ± 3.7) bed-days (p < 0.05). General mortality in the investigated group have constituted 9%, what was in two times lower, than the mortality index in a control group - 16%.
Conclusion. The method, investigated by us, have constituted a combined approach with endoscopic placement of a self-expanding stent into the defect zone together with vacuum therapy from the external aperture of fistula, promoting improvement of the treatment results of the duodenal sutures insufficiency, accompanied by shortening of the patients’ stationary stay and reduction of morbidity and mortality.
References
Boyko VV, Leonov AV, Taraban IA, Lehachov VK, Leonov VV. Lack of intestinal anastomoses. Kharkivska khirurhichna shkola. 2013;6(63):5-8. [In Ukrainian].
Shalkov YL. Intestinal sutures and anastomoses in surgical practice. Kharkov: Binom; 2013. 208 p. [In Russian]. ISBN 978-5-9518-0539-3.
de Zeeuw S, Ahmed Ali U, Donders RA, Hueting WE, Keus F, van Laarhoven CJ. Update of complications and functional outcome of the ileo-pouch anal anastomosis: overview of evidence and meta-analysis of 96 observational studies. Int J Colorectal Dis. 2012;27(7):843-53. doi: 10.1007/s00384-011-1402-6. Epub 2012 Jan 10. Erratum in: Int J Colorectal Dis. 2012 Apr;27(4):553. Ali, Usama Ahmed [corrected to Ahmed Ali, Usama]. PMID: 22228116; PMCID: PMC3378834.
Mehlnyk VM, Poyda OI. Surgical tactics in insufficiency of the interintestinal anastomoses sutures. Klin Khir. 2016;(6):8-12. [In Ukrainian].
Krasilnikov DM, Minnullin MM, Nikolaev YU. Diagnosis and complex treatment of seam’s lack of the gastrointestinal tract of patients with gastric ulcer and duodenal ulcer. Creative surgery and oncology. 2012;(3):49-55. doi: 10.24060/2076-3093-2012-0-3-49-55. [In Russian].
Kelm M, Seyfried F, Reimer S, Krajinovic K, Miras AD, Jurowich C, et al. Proximal jejunal stoma as ultima ratio in case of traumatic distal duodenal perforation facilitating successful EndoVAC® treatment: A case report. Int J Surg Case Rep. 2017;41:401-3. doi: 10.1016/j.ijscr.2017.11.022. PMID: 29546001; PMCID: PMC5699878.
Mayberry J, Fabricant L, Anton A, Ham B, Schreiber M, Mullins R. Management of full-thickness duodenal laceration in the damage control era: evolution to primary repair without diversion or decompression. Am Surg. 2011;77(6):681-5. PMID: 21679632.
Ordoñez C, García A, Parra MW, Scavo D, Pino LF, Millán M, et al. Complex penetrating duodenal injuries: less is better. J Trauma Acute Care Surg. 2014;76(5):1177-83. doi: 10.1097/TA.0000000000000214. PMID: 24747446.
Glatz T, Fischer A, Hoeppner J, Thimme R, Walker C, Richter-Schrag HJ. Vacuum sponge therapy using the pull-through technique via a percutaneous endoscopic gastrostomy to treat iatrogenic duodenal perforation. Endoscopy. 2015;47 Suppl 1:E567-8. doi: 10.1055/s-0034-1393369. Epub 2015 Nov 26. PMID: 26610087.

This work is licensed under a Creative Commons Attribution 4.0 International License.