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Background: The significance of reinforcement of the duodenal stump with seromuscular sutures and the effectiveness of reinforced staplers in preventing duodenal stump leakage remain unclear. We aimed to explore the importance of duodenal stump reinforcement and determine the optimal reinforcement method for preventing duodenal stump leakage. Methods: This retrospective cohort study was conducted between January 1, 2012 and December 31, 2021, with data analyzed between December 1, 2022 and September 30, 2023. This multicenter study across 57 institutes in Japan included 16,475 patients with gastric cancer who underwent radical gastrectomies. Elective open or minimally invasive (laparoscopic or robotic) gastrectomy was performed in patients with gastric cancer. Results: Duodenal stump leakage occurred in 153 (0.93%) of 16,475 patients. The proportions of males, patients aged ≥ 75 years, and ≥ pN1 were higher in patients with duodenal stump leakage than in those without duodenal stump leakage. The incidence of duodenal stump leakage was significantly lower in the group treated with reinforcement by seromuscular sutures or using reinforced stapler than in the group without reinforcement (0.72% vs. 1.19%, p = 0.002). Duodenal stump leakage incidence was also significantly lower in high-volume institutions than in low-volume institutions (0.70% vs. 1.65%, p = 0.047). The rate of duodenal stump leakage-related mortality was 7.8% (12/153). In the multivariate analysis, preoperative asthma and duodenal invasion were identified as independent preoperative risk factors for duodenal stump leakage-related mortality. Conclusions: The duodenal stump should be reinforced to prevent duodenal stump leakage after radical gastrectomy in patients with gastric cancer. [ABSTRACT FROM AUTHOR]

Background: Although duodenal stump leakage (DSL) is a relatively rare complication after gastrectomy with Roux-en-Y (R-Y) reconstruction, it is difficult to treat and can be fatal. We investigated the impact of duodenal stump reinforcement on DSL after laparoscopic gastrectomy with R-Y reconstruction for gastric cancer. Methods: This retrospective study of 965 patients with gastric cancer who underwent laparoscopic distal or total gastrectomy (LDG or LTG) with R-Y reconstruction compared surgical outcomes between two groups, the duodenal stump reinforcement group (reinforcement group) (n = 895) and that without duodenal stump reinforcement (non-reinforcement group) (n = 70). Results: Mean operative duration was significantly longer in the reinforcement than in the non-reinforcement group (LDG; 291 min versus 258 min, p < 0.001, LTG; 325 min versus 285 min, p < 0.001). DSL occurred less frequently in the reinforcement than in the non-reinforcement group (0.67% vs. 5.71%, p < 0.001). Furthermore, non-reinforcement was an independent risk factor for DSL in multiple logistic regression analysis with adjustment for potential confounding factors. Patients with DSL in the non-reinforcement group all required re-operation, while all but one patient with DSL in the reinforcement group recovered with conservative management. Conclusions: Duodenal stump reinforcement in laparoscopic gastrectomy with R-Y reconstruction may reduce the risk of DSL development and minimize its severity. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed to evaluate retrospectively the safety and efficacy of the percutaneous management of duodenal stump leakage with a Foley catheter after subtotal gastrectomy. Methods: Ten consecutive patients (M:F = 9:1, median age: 64 years) were included in this retrospective study. The duodenal stump leakages were diagnosed in all the patients within a median of 10 days (range, 6-20). At first, the patients underwent percutaneous drainage on the day of or the day after confirmation of the presence of duodenal stump leakage, and then the Foley catheters were replaced at a median of 9 days (range, 6-38) after the percutaneous drainage. Results: Foley catheters were placed successfully in the duodenal lumen of all the patients under a fluoroscopic guide. No complication was observed during and after the procedures in all the patients. All of the patients started a regular diet 1 day after the Foley catheter placement. The patients were discharged at a median of 7 days (range, 5-14) after the Foley catheter placement. The catheters were removed in an outpatient clinic 10-58 days (median, 28) after the Foley catheter placement. Conclusions: Fluoroscopy-guided percutaneous Foley catheter placement may be a safe and effective treatment option for postoperative duodenal stump leakage and may allow for shorter hospital stays, earlier oral intake, and more effective control of leakage sites. [ABSTRACT FROM AUTHOR]

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