Catheter Duodenostomy: A Safeguard in Gastric Resection

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THE proper closure of the duodenal stump is a critical step in the safe performance of gastric resections of the Billroth II type. Every surgeon with experience in gastric resections can recall patients in whom leakage from the duodenal stump has resulted in disaster; at best, a stormy convalescence for the patient; at worst, death. Welch1 deserves the credit for calling attention to the simple maneuver of catheter duodenostomy which can obviate this dangerous complication.

The utilization of a deliberately created duodenal fistula at the time of gastric surgery was reported as early as 1881 by Billroth.2 Current interest was stimulated by Welch, in 1949, who pointed out the potential usefulness of a catheter placed in the duodenal stump when proximity of pancreatic or common bile ducts might interfere with proper closure; nutritional depletion of the patient with possible impairment of normal healing processes was an additional reason for employing this safeguard. He stated that he had used the procedure in 2 patients. Welch’s view was endorsed by Priestley and Butler.3 They reported 2 cases in which catheter duodenostomy had been performed, and expressed the belief that, when leakage from the duodenal stump was considered a possibility, it was preferable to drain the duodenum directly by catheter rather than the periduodenal area. Ross and Warren4 mentioned simultaneous catheter duodenostomy and catheter jejunostomy as a safeguard in gastric resection.

It is probable that a safe closure of the duodenum may be performed in nearly every instance if the surgeon will observe. . .



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