duodenal repair?

[McSwain, Norman E Jr.]

Maybe less, maybe more. I have seen them open in 3 days and not open for 6 weeks. This is very variable. It does not seem to matter whether it is stapled or sewn. I know of no definitive literature. Do you?

Norman

Norman McSwain Jr, MD FACS
Trauma Director Charity Hospital
Professor of Surgery
Tulane University School of Medicine
504 988 5111


-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Ronald Simon
Sent: Monday, May 19, 2008 1:40 PM
To: 'Trauma & Critical Care mailing list'
Subject: RE: duodenal repair?

The pyloric closure is temporary. Continuity will be restored in 2-3 weeks
when the vicryl melts.
Ron simon

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of josemaya01
Sent: Monday, May 19, 2008 12:53 PM
To: trauma-list
Subject: Ref:duodenal repair?

I´m a little confused about this, you close the pylorus, but you don´t do a
gastrojejunostomy, you place a G tube so the patient won´t have to bear with
a NG tube, my question is how do you establish GI continuity, the pylorus is
closed and nothing is supposed to travel through the duodenum, the G tube is
in the stomach but does not reach to the jejunum, unless it is only for
decompression.
José Mayagoitia


De : traumamd at nyc.rr.com
Para : "Trauma &amp, Critical Care mailing list" trauma-list at trauma.org
Copia : "Sise, Mike MD" Sise.Mike at scrippshealth.org
Fecha : Sun, 18 May 2008 20:55:52 -0400
Asunto : duodenal repair?


> If i am nervous, i close the pylorus by opening the stomach, grabbing the
pylorus with alice clamps and suture it closed with 2-0 vicryl. I like
vicryl cause it goes away in 2-3 weeks and if the patient is better faster i
get GI to go in and cut the sutures. I do NOT do a gastrojej but i place a
G-tube so the patient doesnt have to sit with an NG tube. I beleive a
gastrojej is just too invasive. Works fine for me for the 5 or so times i
have done it.
> ron simon
> bellevue hospital center
> 
> ---- "Sise wrote: 
> > Duodenal injuries - when to interrupt the pylorus and how to do it.
> > 
> > Difficult duodenal repair for injury to the 4th portion not involving
the pancreas and remote to the ampulla. Through and through 45 caliber
gunshot wound suture closure but concern for the repair. Vena cava also
repaired. 12 units of pRBCs, 12 of FFP and, a 12 pack of platelets. Planning
a temporary abdominal wall closure. Do you interrupt the pylorus and, if so,
how do you do it.
> > 
> > Mike Sise
> > San Diego
> > 
> > "Scripps Information Security" 
> >
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