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Postoperative duodenal fistulas. A report of 23 cases with emphasis on the surgical treatment by the Roux-en-Y operation.

A series of 23 patients-15 with a spontaneous postoperative duodenal fistula and 8 with a catheter duodenostomy fistula-admitted in both departments between 1974 and 1983, is reviewed. Overall mortality rate was 9%. Using conservative management and parenteral nutrition, spontaneous closure of the fistula was observed in 78% of the cases after an average duration of 33 days. Three patients with an intractable fistula were successfully managed by surgical internal drainage using a Roux-en-Y jejunal loop. Healing time of catheter duodenostomy fistulas was similar to that of spontaneous fistulas. Therefore, deliberate creation of such duodenal fistulas should be carefully considered. The Roux-en-Y operation is recommended for those fistulas that do not heal with conservative management. The latter technique could perhaps be used primarily for the closure of difficult duodenal stumps.