Sun Yong, Li Yalei, Zhao Enhong
Department of Gastrointestinal Surgery, Affiliated Hospital of Chengde Medical University, No. 36 Nanyingzi Street, Chengde, 067000, Hebei, China.
Surg Endosc. 2025 Aug 18. doi: 10.1007/s00464-025-12068-7.
Duodenal stump leakage (DSL) is a fairly uncommon but dangerous complication after gastrectomy with Billroth II (B-II) or Roux-en-Y (R-Y) reconstruction. The significance of reinforcing the duodenal stump to prevent DSL during laparoscopic gastrectomy is still under debate. We aimed to explore the clinical impact of duodenal stump reinforcement after laparoscopic gastrectomy with duodenal stump.
We retrospectively collected consecutive patients with gastric cancer from our center between June 2019 and September 2023. Patients who underwent laparoscopic distal or total gastrectomy (LDG or LTG) with R-Y reconstruction or B-II + Braun's anastomosis were included in this study. The clinical and pathological characteristics of patients, their surgical parameters, and postoperative complications were compared.
All the qualified patients were divided into the reinforcement group (n = 303) and the non-reinforcement group (n = 71). Duodenal stump leakage occurred in 6 (1.6%) of 374 patients. Compared to the non-reinforcement group, the incidence of DSL was significantly decreased in the reinforcement group (0.7% vs.5.6%, p = 0.003). The reinforcement group experienced a shorter postoperative duration of stay than the non-reinforcement group (p = 0.002). No statistical differences were observed in terms of overall complications. However, there were significant differences in severe (grades III and IV) complications (p = 0.001).
Duodenal stump reinforcement can reduce the incidence of DSL after laparoscopic gastrectomy with R-Y reconstruction or B-II + Braun's anastomosis. Patients with duodenal stump reinforcement had better outcomes, compared to those without duodenal stump reinforcement. But for certain patients who have difficulty with reinforcement, the reinforcement method should be individually selected based on the circumstances, which deserves further research.
十二指肠残端漏（DSL）是毕罗Ⅱ式（B-II）或 Roux-en-Y（R-Y）重建胃切除术后一种相当罕见但危险的并发症。在腹腔镜胃切除术中加强十二指肠残端以预防 DSL 的意义仍存在争议。我们旨在探讨腹腔镜胃切除术后十二指肠残端加强的临床影响。
我们回顾性收集了 2019 年 6 月至 2023 年 9 月期间本中心连续的胃癌患者。本研究纳入接受 R-Y 重建或 B-II + 布朗吻合术的腹腔镜远端或全胃切除术（LDG 或 LTG）的患者。比较患者的临床和病理特征、手术参数及术后并发症。
所有符合条件的患者分为加强组（n = 303）和非加强组（n = 71）。374 例患者中有 6 例（1.6%）发生十二指肠残端漏。与非加强组相比，加强组 DSL 的发生率显著降低（0.7% 对 5.6%，p = 0.003）。加强组术后住院时间比非加强组短（p = 0.002）。总体并发症方面未观察到统计学差异。然而，严重（Ⅲ级和Ⅳ级）并发症存在显著差异（p = 0.001）。
十二指肠残端加强可降低 R-Y 重建或 B-II + 布朗吻合术的腹腔镜胃切除术后 DSL 的发生率。与未进行十二指肠残端加强的患者相比，进行十二指肠残端加强的患者预后更好。但对于某些难以进行加强的患者，应根据具体情况个体化选择加强方法，这值得进一步研究。
