T‐tube in Duodenal Fistula: Reply

Abstract

Dear Sir,We thank the authors for their interest in our article [1].As described by them about a wide variety of operationsfor this morbid condition, it only displays that not a singletechnique has been found as a panacea. Our study has beenan attempt towards a simple operation for this condition.We feel that there is a bit of misinterpretation regardingplacing the T-tube. It has never been used as a first optionfor a duodenal perforation. Our primary operation is alwaysan omentopexy. It is associated with placement of twodrains as described in the article. T-tube is only placed ifthe repair leaks. As detailed in the article [1], T-tube acts asa vent and stent in this condition.Although the authors dared to place the T-tube in adelayed case, we stress that placing a T-tube needs certainprerequisites: perform the operation for placing the T-tubeas soon as the diagnosis is made, peritoneal lavage, carefulclosure of the fistula around the T-tube as described, andtotal parenteral nutrition supplementation. Placing moretubes adds to the operation time, which may affect theoutcome of the patient.It is without doubts that a proper initial surgery mayprevent this dreadful complication [2]; however, given thetotal number of such surgeries in this part of the world, thiscomplication will continue to occur. Hence, the surgeonmust be ready to face it. We wish that the authors succeedwith this simple technique. Other workers also shouldutilize it, if they are satisfied with our arguments. After all,it is about those patients, who if not successfully managed,may lead to a slow, painful death.References