S. E. Byerly1, E. Lee1, V. Cheng2, I. Shnaydman1, D. Balabanoff-Acosta1, G. Ruiz1, K. Inaba2, L. Pizano1, E. Ginzburg1, G. D. Pust1, G. D. Pust1 1University Of Miami,Division Of Trauma &Critical Care, Department Of Surgery,Miami, FL, USA 2University Of Southern California,Department Of Surgery,Los Angeles, CA, USA
Introduction: Pyloric exclusion with gastrojejunostomy (PEX) for the management of duodenal injuries has
come into question upon recent reviews. Less complex than Berne’s duodenal diverticulization,
this procedure aims to temporarily protect the duodenal repair and prevent septic abdominal
complications. The present study examined the outcomes associated with PEX compared to
primary repair as well as evaluated utilization of PEX in 2010-2014 compared to 2000-2004.
Methods: A retrospective National Trauma Databank (NTDB) study(01/2010-12/2014) including trauma
patients sustaining a duodenal injury was performed. Exclusion criteria included survival<24
hours, AAST duodenal injury<3, pancreaticoduodenectomy, absence of duodenal repair and/or
PEX coded and operative procedure delayed past 24 hours. Demographics, injury data,
interventions and outcomes were abstracted. Patients with PEX were compared to patients who
had primary repair.
Results: Of the 4,019,526 patients sustaining trauma during the study period, 2,348(0.058%) had
duodenal injuries and 160 met inclusion criteria. Median age was 27 years(IQR: 21-37), 87%
were male, and median Injury Severity Score (ISS) was 18(IQR: 10-26). Compared to patients
who underwent repair, patients with PEX sustained higher concomitant pancreatic injuries
(59.5%vs26.3%,p<0.001) with higher infection complications postoperatively
(36.3%vs54.8%,p=0.004) and longer lengths of stay postoperatively (25vs19,p=0.027). After
propensity matching, only ventilator days were longer in the PEX group (mean difference:+5.6
days,95%CI:0.2-11.0,p=0.041) compared to the primary repair control with no significant
difference in infectious complications (p=0.124), hospital length of stay (LOS) (p=0.098), ICU
LOS (p=0.068) or in-hospital mortality (p=0.710). Compared to a decade ago, incidence of PEX
for severe duodenal traumatic injury trended toward decreased utilization, but did not reach
statistical significance (p=0.0892).
Conclusion: Despite the controversy surrounding PEX for the management in severe duodenal trauma, its
frequency in the United States is unchanged since the previous decade. PEX is associated with
more ventilator days but no difference in length of stay, in-hospital mortality or infectious
complications