Muhammedoğlu Bahtiyar, Ay Oguzhan Fatih
Department of General Surgery, Kahramanmaras Sutcu İmam University Medical Faculty, Kahramanmaras 46040, Türkiye.
Department of General Surgery, Kahramanmaras Necip Fazıl City Hospital, Kahramanmaras 46140, Türkiye.
World J Gastrointest Surg. 2024 Sep 27;16(9):3041-3047. doi: 10.4240/wjgs.v16.i9.3041.
Currently, perioperative complications of classic Whipple surgery occur at a rate of approximately 40%. Common complications include delayed gastric emptying, pancreatic fistula, and bile leakage, whereas gastrojejunostomy (GJ) leakage is rare.
This case report will assess the management of a GJ leak in a 71-year-old male patient following the Whipple procedure. After surgery, the patient was transferred to the clinic after four days of intensive care, where vacuum therapy was used to handle a developing subcutaneous collection. The patient, who had bile in the drains and incision during follow-up, underwent endoscopic examination on the 21 day after the operation. An opening of approximately 4 mm was observed in the GJ anastomosis during endoscopy. Five titanium clips were used to close the openings. The drainage of bile decreased to less than 50 mL on the first day after the procedure, and the patient's oral intake was opened.
Current literature reports a GJ leakage rate of 0. 54% following Whipple surgery, with clinical findings lasting on average between 4-34 days. Surgery was the main form of therapy for this case, with a success rate of 84%, and percutaneous drainage was also utilized as a treatment option. This case report is the first to document endoscopic treatment of GJ leaks following the classic Whipple procedure.
目前，经典惠普尔手术的围手术期并发症发生率约为40%。常见并发症包括胃排空延迟、胰瘘和胆漏，而胃空肠吻合口（GJ）漏则较为罕见。
本病例报告将评估一名71岁男性患者在惠普尔手术后发生GJ漏的处理情况。术后，患者在重症监护4天后转至门诊，采用负压疗法处理逐渐形成的皮下积液。随访期间引流管及切口有胆汁引出的患者，在术后第21天行内镜检查。内镜检查发现GJ吻合口有一约4mm的开口。使用5个钛夹封闭开口。术后第一天胆汁引流量减少至50mL以下，患者开始经口进食。
目前文献报道惠普尔手术后GJ漏发生率为0.54%，临床表现平均持续4 - 34天。手术是该病例的主要治疗方式，成功率为84%，经皮引流也作为一种治疗选择。本病例报告首次记录了经典惠普尔手术后GJ漏的内镜治疗。
