Background and Methods

Gastro- or duodenojejunostomy leaks after pancreatoduodenectomy is rare. This study aims to analyze the incidence, management, and outcome of gastro- or duodenojejunostomy leaks after pancreatoduodenectomy based on a single center experience from 2004 to 2020 with a narrative literature review.

Results

Of a total of 1494 pancreatoduodenectomies, eight patients with gastrojejunostomy (n=1) or duodenojejunostomy (n=7) leak were identified from the institutional pancreatic database. All leaks were treated operatively. In two patients dismantling of the duodenojejunostomy, distal gastrectomy, and closure of the pyloric and jejunal side, a percutaneous endoscopic gastrostomy and a feeding jejunostomy ultimately had to be performed after an unsuccessful attempt of gastrojejunostomy and suture of the duodenojejunostomy, respectively. The literature search revealed three more studies specifically addressing this complication after pancreatoduodenectomy (36 patients of a total of 4739 pancreatoduodenectomies). Based on an analysis of the current study and the literature review, the overall incidence of gastro- or duodenojejunostomy leaks after pancreatoduodenectomy was 0.71 % (44/6233 pancreatoduodenectomies). The occurrence of a gastro- or duodenojejunostomy leak was associated with a concomitant postoperative pancreatic fistula in 50 % of the cases, an increased length of hospital stay, and a mortality rate of 15.9 %. Surgical treatment was performed in 84 % of the cases.

Conclusion

Gastro- or duodenojejunostomy leak is a rare complication after pancreatoduodenectomy. Prompt diagnosis and early repair is important. In most cases, a surgical intervention is necessary for a good outcome. Under salvage conditions, a bailout strategy may be to temporarily dismantle the gastro- or duodenojejunal anastomosis.

中文翻译：

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胰十二指肠切除术后胃或十二指肠空肠吻合术泄漏：单中心经验和叙述性文献综述

 背景和方法

胰十二指肠切除术后胃或十二指肠空肠吻合术泄漏很少见。本研究旨在根据 2004 年至 2020 年单中心经验并进行叙述性文献综述，分析胰十二指肠切除术后胃或十二指肠吻合术漏的发生率、处理和结果。

 结果

在总共 1494 例胰十二指肠切除术中，从机构胰腺数据库中发现了 8 例胃空肠吻合术 (n=1) 或十二指肠空肠吻合术 (n=7) 渗漏的患者。所有泄漏均经过手术处理。两名患者在尝试胃空肠吻合术和缝合十二指肠空肠吻合术失败后，最终不得不进行十二指肠空肠吻合术拆除、远端胃切除术以及幽门和空肠侧闭合，最终不得不进行经皮内镜下胃造口术和喂养空肠造口术。文献检索发现了另外三项专门针对胰十二指肠切除术后并发症的研究（总共 4739 例胰十二指肠切除术中的 36 名患者）。根据对当前研究的分析和文献综述，胰十二指肠切除术后胃或十二指肠造口漏的总体发生率为 0.71%（44/6233 胰十二指肠切除术）。 50% 的病例中，胃或十二指肠空肠造口漏的发生与术后并发胰瘘有关，住院时间延长，死亡率为 15.9%。 84%的病例进行了手术治疗。

 结论

胃或十二指肠空肠吻合口漏是胰十二指肠切除术后罕见的并发症。及时诊断和早期修复非常重要。在大多数情况下，为了获得良好的结果，需要进行手术干预。在抢救条件下，救助策略可能是暂时拆除胃或十二指肠空肠吻合术。