Experiences of Surgical Approach for Aortoduodenal Fistula Repairs in Abdominal Aortic Aneurysm Patients

Purpose: This study aimed to analyze the characteristics and outcomes of patients with an aortoduodenal fistula (ADF) who underwent surgical treatment at a single institution.

Materials and methods: The data of patients diagnosed with ADF at the Yonsei University Gangnam Severance Hospital, South Korea, between 2019 and 2022 were included. Primary repair and segmental resection of the duodenum with duodeno-jejunostomy were the two main methods used to repair ADF.

Results: Among the 15 patients analyzed, most were male, and the median age was 68 years. Based on the cause of ADF, five patients had primary ADF, whereas the remaining had secondary ADF. The average duration from fistula diagnosis to surgery was 23.5 days (2.8 days in primary ADF cases and 33.8 days in secondary ADF cases). Primary repair of the ADF was performed for eight patients, and segmental resection of the duodenum with duodeno-jejunostomy was performed for the remaining patients. Omentopexy was performed for all patients. The median duration of hospital stay was 32.7 days. Three patients died after surgery; however, all 11 patients operated on by the single experienced surgeon survived until the last follow-up.

Conclusion: To the best of our knowledge, this study is the first original article on ADF. Our findings suggest that ADF repairs performed by experienced surgeons would provide favorable results. Although primary repair is the first treatment choice, duodeno-jejunostomy is recommended when it is not feasible. By choosing the appropriate procedure depending on the case, favorable outcomes without any fatalities can be achieved.