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Changing Concepts in Management

John R. Kirkpatrick, MD; Thomas Siegel, MD

Arch Surg. 1984;119(6):659-663.

Abstract
• From 1973 through 1983, 197 patients were treated at Harper-Grace Hospital, Detroit, according to a protocol designed to minimize the effects of possible gastrojejunal disruption. All had high-risk resections or bypasses of the stomach reconstructed with an end-to-end Roux-en-Y anastomosis using a long (100-cm) jejunal limb. Eighteen anastomoses leaked, producing fever, pain, and mild respiratory distress in 14 patients and peritonitis with shock in four. Nine of the 14 patients without shock avoided surgery, requiring only antibiotics and nutritional support. The other five had a subphrenic abscess, necessitating drainage. The four patients with shock were treated with staged intestinal discontinuity, nutritional support, and reestablishment of gastrointestinal continuity at a later date. Seventeen patients (94%) survived this serious complication, a significant improvement compared with the mortality of historical controls.

(Arch Surg 1984;119:659-663)

Author Affiliations
From the Department of Surgery, Wayne State University School of Medicine, Detroit.

Footnotes
Accepted for publication Jan 11, 1984.

Read before the 91st annual meeting of the Western Surgical Association, Monterey, Calif, Nov 15, 1983.

Reprint requests to Department of Surgery, Wayne State University School of Medicine, 6-C University Health Center, 4201 St Antoine, Detroit, MI 48201 (Dr Kirkpatrick).

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