Surgical management of Stapfer Type 2 ERCP perforations

Area of Science:

• Gastroenterology
• Surgical Innovation
• ERCP Complications

Background:

• Limited surgical options exist for Stapfer Type 2 ERCP perforations.
• Existing algorithms focus on management but not specific surgical interventions.
• This study addresses the gap in surgical treatment literature for this patient group.

Purpose of the Study:

• To describe a novel surgical approach for Stapfer Type 2 ERCP perforations.
• To contribute surgical procedural details to the existing body of research.
• To evaluate the efficacy of a modified duodenal diverticulization technique.

Main Methods:

• A cohort of 12 patients with Stapfer Type 2 ERCP perforations underwent surgery between 2016 and 2023.
• A modified duodenal diverticulization procedure was performed, including biliary pathway removal, hepaticojejunostomy, and Braun anastomosis.
• This technique builds upon standard duodenal diverticulization for complex duodenal perforations.

Main Results:

• Eleven of the 12 patients achieved successful discharge without complications.
• One patient with delayed diagnosis and preoperative sepsis experienced a fatal outcome due to multiple organ failure.
• The modified duodenal diverticulization demonstrated a high success rate in the majority of cases.

Conclusions:

• Modified duodenal diverticulization presents a viable surgical alternative for Stapfer Type 2 ERCP perforations.
• The triple ostomy method may not sufficiently address the root cause of ERCP-related perforations.
• This technique offers a definitive solution for complex duodenal injuries following ERCP.