“Triple-Tube-Ostomy” Technique for Management
of Duodenal Injuries: A Systematic Review and
Meta-Analysis by Hisham Bahmad in
Research in Pediatrics & Neonatology: Babies
Abstract:
Background: Isolated duodenal injury following blunt
or penetrating trauma remains an extremely rare and one of the most challenging
hitches confronting trauma surgeons. Triple-tube-ostomy (TTO) technique
involving gastrostomy, reverse duodenostomy, and feeding jejunostomy tubes
insertion has shown promising results during conservative management of
duodenal injuries.
Objective: We aim through this paper to report a
successfully managed case of isolated incomplete transverse duodenal injury
managed by TTO technique in a 14-year-old boy who presented with severe
abdominal pain, one day after sustaining ablunt abdominal trauma due to fall
from height. In addition, we aimed to systematically review the literature for
the usage and outcomes of the TTO surgical procedure, and evaluate its
efficiency and effectiveness in the management of duodenal injuries.
Data Sources: OVID/Medline, PubMed, and Scopus
databases were lastly searched on December 8th, 2016 to identify all published
research studies on duodenal injuries treated by this surgical technique.
Study Selection: Studies reporting cases of duodenal
injuries that were managed by TTO were warranting inclusion.
Data Extraction and Synthesis: Both CARE and PRISMA
guidelines were followed for conduction and reporting of this study. Throughout
the whole review process, two reviewers worked independently and in duplicate
to screen titles, assess full texts for eligibility, and abstract data.
Results: Six articles were included in this review.
Sixty five cases were reported to have undergone TTO in world literature.
Majority of the cases were performed after surgical repair of giant duodenal
ulcers, only 2 cases were reported due to perforations following trauma. While
majority of cases had uneventful recovery, complications such as wound
infections and dehiscence were reported. Mean length of hospital stay was found
to be 20.5 days. Mortality occurred in 3 cases.
Conclusion and
Relevance: The positive outcomes of our reported case and the structured
evaluation of the published studies suggest effectiveness of usage of
“triple-tube-ostomy” surgical procedure for management of duodenal injuries.
However, further studies are needed to assess the usage of this technique in
management of duodenal injuries in comparison to other classical surgical
techniques.
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