Side-to-end duodenojejunostomy (Grégoire's technique modified by Stoppa)

Which style of duodenojejunostomy is better after resection of distal duodenum

BACKGROUND

Distal duodenal resections are sometimes necessary for radical surgery, but how to restore duodenal continuity is still unclear. This study aimed at determining which style of anastomosis was more suitable for the duodenojejunostomy after resection of distal duodenum.

PATIENTS AND METHODS

We retrospectively identified 34 patients who underwent distal duodenum resection at our center between January 2014 and December 2021. According to whether the end or the side of the proximal duodenum was involved in reconstruction, duodenojejunostomy were classified as End style (E-style) and Side style (S-style). Demographic data, clinicopathological details, and postoperative complications were analyzed between two groups.

RESULTS

Thirteen patients (38.2%) received E-style duodenojejunostomy, and 21 patients (62.8%) received S-style duodenojejunostomy. Comparative analysis showed that in group of E-style, patients had a lower rate of multivisceral resection(5/13 vs 18/21; P = 0.008), delayed gastric emptying (DGE) (1/13 vs 11/21; P = 0.011) and intraperitoneal infection (2/13 vs 12/21; P = 0.03). In this study, the incidence of major complications was up to 35.3% (12/34) and no patient died of complication in perioperative period. In two group, there was no difference in the incidence of major complications (E-style vs S-style: 3/13 vs 9/21; P = 0.292).

CONCLUSIONS

The E-style duodenojejunostomy for the reconstruction of distal duodenum resection is safe and feasible. The E-style anastomosis may have potential value in decreasing the occurrence of complications such as DGE and intraperitoneal infection, and the definitive advantages still need to be verified.

Two duodenal gastrointestinal stroma tumors: Management by minimally invasive surgery and then by conservative surgery

We report the case of a 48-year-old woman treated for a gastrointestinal stroma tumor of the duodenum after presenting with upper gastrointestinal bleeding. She was treated with a combination of a radiological and endoscopic approach and minimally invasive surgery. During follow-up, the patient developed a second metachronous duodenal gastrointestinal stroma tumor, distinct from a local recurrence. This tumor was treated with a conservative surgical approach.