Stages in treatment of patients with duodenal fistula after gastric resection in peptic ulcer diseases

V.I. Belokonev, I.V. Kharin

Chair of Surgical Diseases № 2 SBEI HPE «Samara State Medical University», Samara, Russia

The results of treatment 74 patients with duodenal fistulas, formed as a result of lack suture after gastrectomy by Billroth - I and Billroth - II are presented in article.

Peritoneal form of dehiscence (fistulas of I, II types) was in 54 (73,0%) patients, fistular form (fistulas of III and type IV) – 20 (27,0%). In peritoneal form of failure of gastro-duodenal anastomosis after gastrectomy by Billroth - I, in the reactive stage of peritonitis repeated gastric resection by Billroth - II was performed. In peritoneal form of failures tump of duodenum used techniques that allow to transfer it into a fistular form: duodenostomy using a Foley catheter, dipnoous drainage using naso-gastrojejuno-duodenal probe, duodenostomy over a length. In fistular form used method of final fistula closure using muscle flap on the pedicle.

Analysis of the treatment results showed that from 17 patients with duodenal fistulas suturing 11 (64,7%) died, while at blind drainage from 17 – 10 died (58,8%), at dipnoous drainage from 6 patients – 3 (50,0%), at gastric re-resection from 26 – 12 (46,1%). If conservative management from 8 patients with primaryfistular form died 2 (25,0%). In peritoneal form of sutureinconsistency 27 patients died from 53 (51,0%), and infistular – 9 from 21 (42,9%). The highest mortality rate (83,3%) was observed in patients with fistulas complicated by peritonitis, in the stage of bacterial shock and multiple organ failure.

Keywords: gastric resection, suture failure, duodenal fistula duodenostomy.

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