title: Antroduodenectomy with Gastroduodenal Anastomosis: Salvage Emergency Surgery for Complicated Peptic Ulcer Disease--Results of a Double Institution Study of 35 Patients.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Hospital Pitié Salpêtrière, APHP, University Pierre et Marie Curie (Paris VI), Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Chereau
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Hospital Pitié Salpêtrière, APHP, University Pierre et Marie Curie (Paris VI), Paris, France.
authors.forename: Marie-Maëlle
authors.initials: MM
authors.lastname: Chandeze
authors.affiliation: Department of Digestive Surgery, Hospital Saint Antoine, APHP, University Pierre and Marie Curie (Paris VI), Paris, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Tantardini
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Hospital Pitié Salpêtrière, APHP, University Pierre et Marie Curie (Paris VI), Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Trésallet
authors.affiliation: Department of Digestive Surgery, Hospital Saint Antoine, APHP, University Pierre and Marie Curie (Paris VI), Paris, France.
authors.forename: Jérémie H
authors.initials: JH
authors.lastname: Lefevre
authors.affiliation: Department of Digestive Surgery, Hospital Saint Antoine, APHP, University Pierre and Marie Curie (Paris VI), Paris, France.
authors.forename: Yann
authors.initials: Y
authors.lastname: Parc
authors.affiliation: Department of General, Digestive and Endocrine Surgery, Hospital Pitié Salpêtrière, APHP, University Pierre et Marie Curie (Paris VI), Paris, France. fabrice.menegaux@aphp.fr.|Department of General, Digestive and Endocrine Surgery, Hospital Pitie Salpêtrière, 47-83 boulevard de l'hôpital, 75651, Paris Cedex 13, France. fabrice.menegaux@aphp.fr.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Menegaux
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D015331:Cohort Studies; D004381:Duodenal Ulcer / Q000150:complications / Q000601:surgery*; D004630:Emergencies; D005260:Female; D018530:Gastric Stump / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D010439:Peptic Ulcer Perforation / Q000150:complications / Q000601:surgery*; D012307:Risk Factors; D016879:Salvage Therapy; D016896:Treatment Outcome; D055815:Young Adult
keywords: Antroduodenectomy; Bleeding duodenal ulcer; Complicated ulcer disease; Perforated duodenal ulcer; Salvage surgery