Surgical management of penetrating duodenal injury: Role of primary repair

Abstract

Objective: To evaluate the outcome of primary repair in penetrating duodenal injuries. Study Design: Descriptive study. Place and Duration of Study: Adana City Training and Research Hospital, Adana, Turkey, between March 2011 and September 2018 Methodology: Patients with penetrating duodenal injury, who underwent primary repai, were reviewed retrospectively. The patients who had early death, grade 1 duodenum injuries and operative procedures except primary repair, were excluded from the study. Age, gender, mechanism of penetrating injury, grade of the duodenal injury, associated intra-abdominal injuries, length of intensive care unit and hospital stay, duodenum-related mortality and morbidity were analysed. Fisher's exact test was used to compare the outcomes between survivor and non-survivor groups. Results: Data of 26 patients with primary repair (5 females, 21 males) were reviewed. The mean age was 33.11 ±12.07 years; and gunshot (n=19, 73.1%) was the most common cause of the duodenal injury. Twenty-five had a total of 103 (3.9 injuries per patient) associated intra-abdominal organ injuries. 20 (76.9%) patients had grade 2 duodenal injuries; and the most injured portion of the duodenum was segment IV (n: 9, 34.6%). Three (11.5%) patients had duodenal leakage and postoperative complication rate was 53.8%. Duodenum-related mortality (DRM) was 3.8% (n:1) and overall mortality was 19.2% (n:5). The anatomic localisation of duodenal injury and associated vascular trauma were significantly different between survivor and non-survivor groups (p: 0.038, and p: 0.034, respectively). Conclusion: Associated intra-abdominal organ and vascular injuries were predictive factors of overall mortality in duodenal injuries. Duodenum-related mortality was low, for this reason minimally invasive procedures such as primary repair will be more accurate in surgical management of penetrating duodenal injuries.