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How to manage difficult duodenal defects? Single center experience.
Tufan Egeli1, Özgür Çavdaroğlu1, Cihan Ağalar1
1Department of General Surgery, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye.
Turkish Journal of Surgery
|December 4, 2024
Summary
Surgical repair of difficult duodenal defects (≥2 cm) showed a 31.6% mortality rate. Primary repair is feasible for less severe cases, while duodenojejunostomy offers a safe alternative for complex perforations and salvage procedures.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Abdominal Surgery
Background:
- Difficult duodenal defects, defined as perforations of 2 cm or larger, present significant surgical challenges.
- Etiologies vary, including peptic ulcer disease, fistulas, and iatrogenic injuries, impacting patient outcomes.
Purpose of the Study:
- To investigate surgical treatment methods and outcomes for difficult duodenal defects.
- To identify risk factors associated with morbidity and mortality in these patients.
Main Methods:
- A retrospective analysis of 19 patients with difficult duodenal defects (≥2 cm) treated between January 2012 and November 2022.
- Evaluation of patient demographics, perforation etiology, American Society of Anesthesiology (ASA) scores, Mannheim Peritonitis Index (MPI), surgical procedures, re-operations, and outcomes.
Main Results:
- Peptic ulcer perforation was the most common etiology (63.1%).
- Primary repair (duodenoraphy + omentopexy, Graham repair) and duodenojejunostomy were employed. Four patients required salvage surgery, primarily Roux-en-Y duodenojejunostomy.
- Overall mortality was 31.6%, with high ASA scores and MPI identified as significant risk factors for mortality.
Conclusions:
- Primary repair is suitable for select difficult duodenal defects with minimal peritonitis.
- Duodenojejunostomy is a fast, easy, and safe option for both initial and salvage surgeries in complex cases.
- Risk stratification using ASA scores and MPI is crucial for managing patients with difficult duodenal defects.
