Skip to main content
SpringerLink
Log in

Antroduodenectomy with Gastroduodenal Anastomosis: Salvage Emergency Surgery for Complicated Peptic Ulcer Disease—Results of a Double Institution Study of 35 Patients

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

Endoscopic and interventional techniques are currently the mainstay of management of bleeding duodenal ulcer. As well, for patients with perforated duodenal ulcer, laparoscopic simple closure is nowadays usually performed. Although indications for emergency antroduodenectomy have declined, this procedure is still necessary as a salvage option when conservative management has failed or is not practicable. Our study aimed to evaluate indications and results of antroduodenectomy with gastroduodenal anastomosis in current practice and to examine the factors that predict operative outcomes.

Methods

All patients who underwent emergency antroduodenectomy with gastroduodenal anastomosis in two surgical care departments specialized in emergency digestive surgery were studied from 2000 to 2015.

Results

Thirty-five patients (27 males, 77 %) with a median age of 68 years (20–90) underwent emergency antroduodenectomy with gastroduodenal anastomosis. Indications were bleeding and perforated duodenal ulcer in 24 and 11 patients, respectively. The overall complication rate was 69 %, especially because of a high rate of medical complications (57 %). Only two patients (6 %) required reoperation for anastomotic leakage. The overall mortality rate was 40 % (n = 14). According to the univariate analysis, age >70, >3 comorbidities, ASA score >2, and postoperative medical complications were associated with an increased risk of in-hospital mortality. In the multivariate analysis, age and ASA score remained independent risk factors. No recurrence of complicated duodenal disease was observed.

Conclusion

Antroduodenectomy with gastroduodenal anastomosis is a safe and effective long-term strategy, with a low and acceptable rate of surgical complications, for complicated duodenal ulcer not responding to conservative measures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Paimela H, Oksala NK, Kivilaakso E. Surgery for peptic ulcer today. A study on the incidence, methods and mortality in surgery for peptic ulcer in Finland between 1987 and 1999. Dig Surg 2004;21:185–91.

    Article  CAS  PubMed  Google Scholar 

  2. Svanes C. Trends in perforated peptic ulcer: incidence, etiology, treatment, and prognosis. World J Surg 2000;24:277–83.

    Article  CAS  PubMed  Google Scholar 

  3. Millat B, Hay JM, Valleur P, Fingerhut A, Fagniez PL. Emergency surgical treatment for bleeding duodenal ulcer: oversewing plus vagotomy versus gastric resection, a controlled randomized trial. French Associations for Surgical Research. World J Surg. 1993 Sep-Oct;17(5):568–73;

  4. Poxon VA, Keighley MR, Dykes PW, Heppinstall K, Jaderberg M. Comparison of minimal and conventional surgery in patients with bleeding peptic ulcer: a multicentre trial. Br J Surg. 1991 Nov;78(11):1344–5

  5. Dousset B, Suc B, Boudet MJ, Cherqui D, Rotman N, Julien M, Fagniez PL. Surgical treatment of severe ulcerous hemorrhages: predictive factors of operative mortality. Gastroenterol Clin Biol. 1995 Mar;19(3):259–65.

  6. Imhof M, Epstein S, Ohmann C, Röher HD. Poor late prognosis of bleeding peptic ulcer. Langenbecks Arch Surg. 2007 Sep;392(5):587–91.

  7. Nahon S, Pariente A; group of investigators of the ANGH (Association Nationale des Gastroentérologues des Hôpitaux Généraux). Impact of comorbidity on mortality in patients with peptic ulcer bleeding: confirmative data of a French prospective study. Am J Gastroenterol. 2013 Sep;108(9):1532–3.

  8. Leontiadis GI, Molloy-Bland M, Moayyedi P et al. Effect of comorbidity on mortality in patients with peptic ulcer bleeding: systematic review and meta analysis . Am J Gastroenterol 2013; 108 : 331 – 45

    Article  PubMed  Google Scholar 

  9. De la Fuente SG, Khuri SF, Schifftner T, Henderson WG, Mantyh CR, Pappas TN. Comparative analysis of vagotomy and drainage versus vagotomy and resection procedures for bleeding peptic ulcer disease: results of 907 patients from the Department of Veterans Affairs National Surgical Quality Improvement Program database. J Am Coll Surg. 2006 Jan;202(1):78–86

  10. Dubois F (1971) Gastrectomy and gastroduodenal anastomosis for post-bulbar ulcers and peptic ulcers of the second part of the duodenum. J Chir 101:177–186

    CAS  Google Scholar 

  11. Loffroy R. Management of duodenal ulcer bleeding resistant to endoscopy: surgery is dead! World J Gastroenterol. 2013 Feb 21;19(7):1150–1

  12. Wu X, Zen D, Xu S, Zhang L, Wang P. A modified surgical technique for the emergent treatment of giant ulcers concomitant with hemorrhage in the posterior wall of the duodenal bulb. Am J Surg. 2002 Jul;184(1):41–4

  13. Guinier D, Destrumelle N, Denue PO, Mathieu P, Heyd B, Mantion GA. Technique of antroduodenectomy without ulcer excision as a safe alternative treatment for bleeding chronic duodenal ulcers. World J Surg. 2009 May;33(5):1010–4

  14. Oh SJ, Choi WB, Song J, Hyung WJ, Choi SH, Noh SH. Complications requiring reoperation after gastrectomy for gastric cancer: 17 years experience in a single institute. J Gastrointest Surg 2009; 13: 239–245

    Article  PubMed  Google Scholar 

  15. Takahashi T, Yamamura T, Utsunomiya J. Pathogenesis of acute cholecystitis after gastrectomy. Br J Surg 1990; 77:536–539

    Article  CAS  PubMed  Google Scholar 

  16. Yi S, Ohta T, Tsuchida A et al. (2007) Surgical anatomy of innervation of the gallbladder in humans and Suncus murinus with special reference to morphological understanding of gallstone formation after gastrectomy. World J Gastroenterol 13: 2066–2071

    Article  PubMed Central  PubMed  Google Scholar 

  17. Gutierrez de la Pena C, Marquez R, Fakih F, Dominguez-Adame E, Medina J. Simple closure or vagotomy and pyloroplasty for the treatment of a perforated duodenal ulcer: comparison of results. Dig Surg 2000; 17: 225–228

    Article  CAS  PubMed  Google Scholar 

  18. Lee YT, Sung JJ, Choi CL, Chan FK, Ng EK, Ching JY et al. Ulcer recurrence after gastric surgery: is Helicobacter pylori the culprit? Am J Gastroenterol 1998; 93: 928–931

    Article  CAS  PubMed  Google Scholar 

  19. Lau JY, Sung JJ, Lam YH, et al. Endoscopic retreatment compared with surgery in patients with recurrent bleeding after initial endoscopic control of bleeding ulcers. N Engl J Med 1999;340:751–6.

    Article  CAS  PubMed  Google Scholar 

  20. So JB, Yam A, Cheah WK, Kum CK, Goh PM. Risk factors related to operative mortality and morbidity in patients undergoing emergency gastrectomy. Br J Surg 2000;87:1702–7.

    Article  CAS  PubMed  Google Scholar 

  21. Hunt PS, McIntyre RL. Choice of emergency operative procedure for bleeding duodenal ulcer. Br J Surg. 1990 Sep;77(9):1004–6.

  22. Kumar K, Pai D, Srinivasan K, Jagdish S, Ananthakrishnan N. Factors contributing to releak after surgical closure of perforated duodenal ulcer by Graham’s Patch. Trop Gastroenterol 2002;23:190–2.

    CAS  PubMed  Google Scholar 

  23. Sillakivi T, Lang A, Tein A, Peetsalu A. Evaluation of risk factors for mortality in surgically treated perforated peptic ulcer. Hepatogastroenterology 2000;47:1765–8.

    CAS  PubMed  Google Scholar 

  24. Kocer B, Surmeli S, Solak C, et al. Factors affecting mortality and morbidity in patients with peptic ulcer perforation. J Gastroenterol Hepatol 2007;22:565–70.

    Article  PubMed  Google Scholar 

  25. Schwarze ML, Barnato AE, Rathouz PJ, Zhao Q, Neuman HB, Winslow ER, Kennedy GD, Hu YY, Dodgion CM, Kwok AC, Greenberg CC. Development of a list of high-risk operations for patients 65 years and older. JAMA Surg. 2015 Apr;150(4):325–31.

  26. Quan S, Frolkis A, Milne K, Molodecky N, Yang H, Dixon E, Ball CG, Myers RP, Ghosh S, Hilsden R, van Zanten SV, Kaplan GG. Upper-gastrointestinal bleeding secondary to peptic ulcer disease: incidence and outcomes. World J Gastroenterol. 2014 Dec 14;20(46):17568–77

  27. Rosenstock SJ, Møller MH, Larsson H, Johnsen SP, Madsen AH, Bendix J, Adamsen S, Jensen AG, Zimmermann-Nielsen E, Nielsen AS, Kallehave F, Oxholm D, Skarbye M, Jølving LR, Jørgensen HS, Schaffalitzky de Muckadell OB, Thomsen RW. Improving quality of care in peptic ulcer bleeding: nationwide cohort study of 13,498 consecutive patients in the Danish Clinical Register of Emergency Surgery. Am J Gastroenterol. 2013 Sep;108(9):1449–57

Download references

Author information

Authors and Affiliations

  1. Department of General, Digestive and Endocrine Surgery, Hospital Pitié Salpêtrière, APHP, University Pierre et Marie Curie (Paris VI), Paris, France

    Nathalie Chereau, Marie-Maëlle Chandeze, Christophe Trésallet & Fabrice Menegaux

  2. Department of Digestive Surgery, Hospital Saint Antoine, APHP, University Pierre and Marie Curie (Paris VI), Paris, France

    Camille Tantardini, Jérémie H. Lefevre & Yann Parc

  3. Department of General, Digestive and Endocrine Surgery, Hospital Pitie Salpêtrière, 47-83 boulevard de l’hôpital, 75651, Paris Cedex 13, France

    Fabrice Menegaux

Authors
  1. Nathalie Chereau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marie-Maëlle Chandeze
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Camille Tantardini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christophe Trésallet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jérémie H. Lefevre
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yann Parc
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Fabrice Menegaux
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fabrice Menegaux.

Ethics declarations

Conflict of Interest

The authors declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chereau, N., Chandeze, MM., Tantardini, C. et al. Antroduodenectomy with Gastroduodenal Anastomosis: Salvage Emergency Surgery for Complicated Peptic Ulcer Disease—Results of a Double Institution Study of 35 Patients. J Gastrointest Surg 20, 539–545 (2016). https://doi.org/10.1007/s11605-015-3050-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-015-3050-6

Keywords

Search

Navigation