Comparison of Various Techniques for Repair of Large Duodenal wall Defects: an Experimental Study

Background/Purpose: Duodenal defects still pose a formidable challenge to surgeons. The failure to repair them properly may result in a high output duodenal fistula, which is catastrophic and may even be fatal. The aim of this study was to compare the results of four different surgical techniques used for the repair of large duodenal defects in an experimental model. Methods: A duodenal defect including >= 50% of the circumference and constitutes about 6 cm in length was created in the lateral wall of the second part of the duodenum in 40 healthy dogs. They were divided into 4 equal groups, each group 10 animals. Duodenal defects in animals of group I were repaired by primary duodenorraphy and used as a control. The effectiveness of pedicled jejunal flap (group II), Roux-en-Y side-to-side duodenojejunostomy (group III), and expanded polytetrafluoroethylene patch repair (group IV) techniques were investigated. Fifteen days were set as survival criteria. Repair techniques were investigated on the basis of survival, radiological examination, and postmortem gross and histological features. Results: Six animals survived in group I, nine animals survived in each of group II and III, while no mortality was found in group IV. No significant survival benefit was observed between group II, III, and IV, but they had better survival than group I. Radiological examination showed <= 50% stenosis in the repaired duodenum in group I, while the duodenal passage was well-maintained in group II, and IV. In group III, the passage of contrast media was demonstrated in both the duodenal and the jejunal routes. At the time of autopsy, the vascular pedicles were found pulsating with no thrombosis in group II. Postmortem examination after 2 weeks showed complete serosal and mucosal healing of the duodenojejunal anastomosis in both group II and III. Complete serosal coverage of expanded polytetrafluoroethylene patch was observed after 2 weeks, while complete mucosal healing did not occur even after 12 weeks. Conclusion: The primary repair of large duodenal defects is risky, while the autologous pedicled jejunal flap or Roux-en-Y duodenojejunostomy could be suitable and safe options. Expanded polytetrafluoroethylene patches can be used in only selected situations.