Reinforcement methods of duodenal stump after laparoscopic gastrectomy for gastric cancer: A review

Abstract

Duodenal stump fistula is a rare but dangerous complication of gastric cancer surgery. Reinforcement of the duodenal stump was suggested as a useful method to prevent the occurrence of duodenal stump fistula. Although laparoscopic surgery has been established as a safe procedure for gastric cancer, it is acknowledged that the application of duodenal stump reinforcement is a demanding process in laparoscopic radical gastrectomy. This review aims to provide a concise description of the proposed reinforcement methods of duodenal stump after laparoscopic radical gastrectomy for gastric cancer by summarizing the relevant literature written in English. The thorough knowledge of these reinforcement techniques may help surgeons to find the most suitable reinforcement method of duodenal stump for patients.

Keywords: Duodenal stump fistula; Duodenal stump reinforcement; Gastric cancer; Laparoscopic gastrectomy.

Fig. 1

Flow chart of literature search.

Fig. 2

Illustration of the Lembert suture technique. (A–B) The duodenal staple line was reinforced by interrupted Lembert suture using absorbable 3-0 sutures. (C) Completed view of duodenal stump reinforcement (adapted from reference 16).

Fig. 3

Illustration of the Barbed suture technique. (A) Duodenal stump reinforcement starts from the upper end with a triangular suture using a barbed suture. (B–C) Reinforcement with continuous suture forward the lower end, with a triangular suture at the end. (D) Completed view of the reinforced invaginated duodenal stump line (adapted from reference 24).

Fig. 4

Illustration of the Single Purse-String Suture. (A) A seromuscular purse-string suture is placed 1.0–1.5 cm away from the duodenal stump. (B–C) The knots are tightened and reinforced while the duodenal stump is fully pushed into the purse-string suture. (D) The view of completed reinforcement (adapted from reference 25).

Fig. 5

Illustration of the handover method. (A) A hemi-purse-string suture is placed at the upper end with three seromuscular stitches. (B) The knots are tightened with the upper end pushed in the hemi-purse-string suture. (C) The lower end of the staple line is reinforced with another hemi-purse-string suture. (D–E). The staple line between the wrapped U-corner and I-corner is reinforced with interrupted Lembert suture. (F). View of the completed reinforcement (adapted from reference 13).