World Journal of Surgery

, Volume 32, Issue 1, pp 7–12 | Cite as

Safety of Repair for Severe Duodenal Injuries

  • George C. VelmahosEmail author
  • Constantinos Constantinou
  • George Kasotakis



There is ongoing debate about the management of severe duodenal injuries (SDIs), and earlier studies have recommended pyloric exclusion. The objective of this study was to compare primary repair with pyloric exclusion to examine if primary repair can be safely used in SDIs.


The medical records of 193 consecutive patients who were admitted between August 1992 and January 2004 with duodenal injuries were reviewed. After excluding early deaths (n = 50), low-grade duodenal injuries (n = 81), and pancreatoduodenectomies for catastrophic trauma (n = 12), a total of 50 patients with SDIs (grade III, IV, or V) were analyzed. Primary repair (PR—simple duodenorrhaphy or resection and primary anastomosis) was performed in 34 (68%) and pyloric exclusion (PE) in 16 (32%). Characteristics and outcomes of these two groups were compared.


PE and PR patients were similar for age, injury severity score, abdominal abbreviated injury score, physiologic status on admission, time to operation, and most abdominal organs injured. PE patients had more pancreatic injuries (63% vs. 24%, p < 0.01), a higher frequency of injuries to the first and second part of the duodenum (79% vs. 42%, p = 0.02), and a nonsignificant trend toward more grade IV and V injuries (37% vs. 18%, p = 0.11). There was no difference in morbidity (including complications specific to the duodenal repair), mortality, and intensive care unit and hospital length of stay between the two groups.


Pyloric exclusion is not necessary for all patients with SDIs, as previously suggested. Selected SDI patients can be safely managed by simple primary repair.


Injury Severity Score Primary Repair Primary Anastomosis Pancreatic Injury Duodenal Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  • George C. Velmahos
    • 1
    • 2
    Email author
  • Constantinos Constantinou
    • 1
    • 3
  • George Kasotakis
    • 1
    • 4
  1. 1.Division of Trauma and Critical Care, Department of SurgeryLos Angeles County and University of Southern California Medical CenterLos AngelesUSA
  2. 2.Department of SurgeryMassachusetts General Hospital, Harvard Medical SchoolBostonUSA
  3. 3.Department of SurgeryGeisinger Medical CenterDanvilleUSA
  4. 4.Department of SurgeryCreighton University Medical CenterOmahaUSA

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