The duodenal stump leakage: May it be foreseen and prevented?

The interesting research of Chu Patricia et al., confirms the important clinical impact of the duodenum (D) stump leakage after distal gastrectomy, also today followed by not negligible morbidity and mortality.1–3 This carries interesting points of discussion concerning indications and surgical techniques in case of an ‘incompetent’ D stump, that is unsuitable to a safe closure, as shorter than half of its lumen, provided of fibrotic walls or deteriorated by a difficult dissection. These conditions, commonly found at surgery, can be pre-operatively suspected on the base of gastrointestinal Rx series or CT scans, as correlated with penetrating post-bulbar ulcers, chronic pancreatitis, or cholecystitis, entailing a complete bulbar excision.

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