Duodenal Leakage—Damage Control Using Modified Tube Duodenostomy

Abstract

After emergency duodenal repair, the post-operative duodenal leakage rate ranges from 2 to 12% and is associated with high mortality. Furthermore, no standard management protocol is available in the high-risk post-operative duodenal leakage setting. We aimed to review our experiences of modified tube duodenostomy (one gastric opening for trans-gastric tube duodenostomy, trans-gastric feeding tube jejunostomy, and peri-duodenal external drainage) for high-risk post-operative duodenal leakage patient and describe outcomes and clinical characteristics. From 2008 to 2019, eight consecutive patients in a high-risk post-operative duodenal leakage setting underwent modified tube duodenostomy (mTD). Post-operative mortality or low of follow-up were developed in three patients, and these case details with post-operative duodenal leakage were reviewed. The modified tube duodenostomy operations were performed for duodenal ulcer bleeding and perforation in all eight patients. The leakage developed in five patients, and there were 2 deaths in early post-operative period because of multiple organ failure. In survived patients, mean post-operative intensive care unit (ICU) stay was 30.8 days, and mean overall hospital stay day was 89.8 days. Mean enteral feeding was started at 6.5 days post-operatively. In leakage-developed patients who survived, external peri-duodenal drainage and duodenostomy tube removals were performed at 38 and 50 days post-operatively. We describe for the first time modified tube duodenostomy, which in our experience is easy and simple. In particular, modified tube duodenostomy should be considered a surgical option in the high-risk post-operative duodenal leakage setting. According to our experience and despite its several limitations, modified tube duodenostomy was technically feasible in terms of long-term critical and general care in a peri-operative hemodynamically unstable state. However, to gain further information on the topic, we suggest multicenter studies be conducted to further delineate clinical outcomes and the clinical feasibility of modified tube duodenostomy.