Duodenal fistula after Elective Gastrectomy for malignant disease

Luca Cozzaglio, Massimiliano Coladonato, Roberto Biffi, Arianna Coniglio, Vittorio Corso, Paolo Dionigi, Luca Gianotti, Vincenzo Mazzaferro, Paolo Morgagni, Fausto Rosa, Riccardo Rosati, Francesco Roviello, Roberto Doci

Research output: Contribution to journalArticlepeer-review


Background: Duodenal fistula (DF) after gastrectomy continues to be a life-threatening problem. We performed a retrospective multicenter study analyzing the characteristics of DF after elective gastrectomy for malignant disease. Methods: Three thousand seven hundred eighty-five patients who had undergone gastrectomy with duodenal stump in 11 Italian surgical units were analyzed. Results: Sixty-eight DFs occurred, with a median frequency of 1.6% and a mortality rate of 16%. Complications were mainly septic but fistulas or bleeding of surrounding organs accounted for about 30%. Reoperation was performed in 40% of patients. We observed a correlation between mortality and age (hazard ratio 1.09; 95% CI 1.00-1.20) and serum albumin (hazard ratio 0.90; 95% CI 0.83-0.99). The appearance of further complications was associated with reoperation (P <0.001) and death (P = 0.054), while the preservation of oral feeding was related to DF healing (P <0.001). Conclusions: This paper represents the largest series ever published on DF and shows that its features have changed in the last 20 years. DF alone no longer leads to death and some complications observed in the past have disappeared, while new ones are emerging. Nowadays, medical therapy is preferred and surgery is indicated only in cases of abdominal sepsis or bleeding.

Original languageEnglish
Pages (from-to)805-811
Number of pages7
JournalJournal of Gastrointestinal Surgery
Issue number5
Publication statusPublished - 2010


  • Complications
  • Duodenal fistula
  • Gastrectomy

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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