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May 1988

Safe Management of the Impossible DuodenumRisk Avoidance in Surgery of Peptic Ulcer

Author Affiliations

From the Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston.

Arch Surg. 1988;123(5):558-562. doi:10.1001/archsurg.1988.01400290040006

• A series of 1068 operations for peptic ulcer has been analyzed for evidence of mortality or morbidity related to duodenal dissection or closure. There were 85 patients with catheter duodenostomy and 43 additional patients with acute pancreatitis or duodenal leak. The mortality rate was 17.2% for the entire group of 128 patients. Complications included acute pancreatitis, subphrenic or subhepatic abscess, duodenal blowout, and stomal delay. Forty-two secondary operations were required. Another series of 61 patients was treated by truncal vagotomy and a new technique of antrectomy with intramural dissection and gastroduodenostomy. The mortality rate in this series was 1.6%. Complications included stomal delay, thromboembolism, and gastric leak following gastrostomy tube removal. No secondary operations were required.

(Arch Surg 1988;123:558-562)