title: Application of purse-string suture for management of duodenal stump in radical gastrectomy.
abstract: BACKGROUND
  Gastric cancer (GC) is the second leading cause of cancer mortality worldwide, and surgical resection is currently the only possible curative approach. Duodenal stump leakage is the most serious complication after radical gastrectomy, and optimal treatment is still lacking.
  
  
  METHODS
  We retrospectively reviewed 2034 cases of total or subtotal gastrectomy for GC from January 1995 to December 2009, including 465 cases of duodenal stump closure using purse-string suture (group A), 835 cases of duodenal stump treated with linear cutting stapler and seromuscular layer suture (group B), and 734 cases of duodenal stump closure using full-thickness and seromuscular layer suture (group C). We evaluated the surgical cost, operative time for duodenal stump closure, short-term postoperative complications, perioperative blood loss, and postoperative recovery.
  
  
  RESULTS
  There was no perioperative mortality in any group. Ninety-four postoperative (within 1 month) complications occurred: 18 abdominal bleeding, 14 anastomotic leakage, 15 abdominal infection, 36 wound infection, and 11 duodenal stump leakage. There was no significant difference among the groups in intra-abdominal hemorrhage, anastomotic leakage, abdominal infection and wound infection. No postoperative duodenal stump leakage occurred in group A, which had a significant difference compared with groups B and C (6 cases in group B and 5 cases in group C suffered duodenal stump leakage. P < 0.01). The surgical cost in groups A and C was significantly lower than in group B (P < 0.01), with no significant difference between groups A and C. The processing time for duodenal stump closure in groups A and B was significantly shorter than in group C (P < 0.01), with no significant difference between groups A and B. There was no significant difference in blood loss and postoperative recovery among the groups.
  
  
  CONCLUSIONS
  Duodenal stump closure using purse-string suture seems to be a promising approach with shorter operative time, and lower cost and incidence of duodenal stump leakage in radical gastrectomy.
authors.affiliation: Department of General Surgery, Zhejiang Province People's Hospital, Hangzhou, Zhejiang 310014, China. zhumf@zhdx.gov.cn
authors.forename: Qin-Shu
authors.initials: QS
authors.lastname: Shao
authors.forename: Yong-Xiang
authors.initials: YX
authors.lastname: Wang
authors.forename: Zai-Yuan
authors.initials: ZY
authors.lastname: Ye
authors.forename: Zhong-Kuo
authors.initials: ZK
authors.lastname: Zhao
authors.forename: Ji
authors.initials: J
authors.lastname: Xu
mesh_terms: D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D018530:Gastric Stump / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery; D012189:Retrospective Studies; D013537:Sutures