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Totally laparoscopic gastrectomy using intracorporeally stapler or hand-sewn anastomosis for gastric cancer: a single-center experience of 478 consecutive cases and outcomes.

Chen K, Wu D, Pan Y, Cai JQ, Yan JF, Chen DW, Maher H, Mou YP - World J Surg Oncol (2016)

Bottom Line: For overall patients, the mean operation time and anastomotic time were 225.7 and 30.0 min, respectively.Postoperative complications were observed in 65 patients.All of the patients recovered well without perioperative death by conservative or surgical management.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qing Chun Road, Hangzhou, 310016, Zhejiang Province, China.

ABSTRACT

Background: Totally laparoscopic gastrectomy (TLG) using intracorporeal anastomosis has gradually become mature thanks to the advancements of laparoscopic surgical instruments and the accumulation of operative experience. The goal of this study is to review our institution's experience with TLG for the treatment of gastric cancer.

Methods: A retrospective study was conducted to examine the short-term outcomes of TLG using intracorporeally stapler or hand-sewn anastomosis performed at Sir Run Run Shaw Hospital between March 2007 and June 2015. The details of intracorporeal anastomosis were described, and the clinicopathological data, surgical outcomes, and postoperative complications were evaluated.

Results: Four hundred seventy-eight patients were included in the study. Generally speaking, the patients could be divided into stapler or hand-sewn groups according to whether intracorporeal anastomosis was performed by only hand-sewn technique (n = 97) or only stapling devices (n = 381). For overall patients, the mean operation time and anastomotic time were 225.7 and 30.0 min, respectively. Postoperative complications were observed in 65 patients. All of the patients recovered well without perioperative death by conservative or surgical management.

Conclusions: TLG using intracorporeally stapler or hand-sewn anastomosis is a reasonable option for the treatment of gastric cancer, with early data showing acceptable perioperative outcomes.

No MeSH data available.


Related in: MedlinePlus

Intracorporeal linear stapler side-to-side esophagojejunostomy. a One hole was created on the posterior wall of the esophageal stump. b The other hole was created on the antimesenteric side of the efferent jejunal. c Each jaw of the linear stapler was inserted into the holes on the esophageal stump and the jejunum, and then, the linear stapler fired. d The entry hole and esophagus were closed using staplers
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Fig3: Intracorporeal linear stapler side-to-side esophagojejunostomy. a One hole was created on the posterior wall of the esophageal stump. b The other hole was created on the antimesenteric side of the efferent jejunal. c Each jaw of the linear stapler was inserted into the holes on the esophageal stump and the jejunum, and then, the linear stapler fired. d The entry hole and esophagus were closed using staplers

Mentions: Mechanical stapler methods: conventional circular stapler-anvil method (type A): The stomach was lifted up, and a purse-string suture was placed at 1 cm above the predetermined transected line (Fig. 2a). A hole was made at the esophagogastric junction using the Harmonic scalpel. The anvil was introduced into the esophageal stump through the hole, and the purse-string suture was tied (Fig. 2b). The esophagogastric junction was divided, and the stomach was extracted. The circular stapler was introduced into the jejunum through the jejunal stump (Fig. 2c). The circular stapler attached with the anvil and fired (Fig. 2d). The jejunal stump was closed with endoscopic linear staplers. Linear stapler method (type B): A small opening was made 10 cm from the stump on the distal jejunum (Fig. 3a), and the latter was then pulled up to the esophagus, in which a small side opening was also made (Fig. 3b). A side-to-side antiperistaltic esophagojejunostomy was then performed using linear staplers (Fig. 3c), and then, the entry hole and esophagus were closed using staplers (Fig. 3d).Fig. 2


Totally laparoscopic gastrectomy using intracorporeally stapler or hand-sewn anastomosis for gastric cancer: a single-center experience of 478 consecutive cases and outcomes.

Chen K, Wu D, Pan Y, Cai JQ, Yan JF, Chen DW, Maher H, Mou YP - World J Surg Oncol (2016)

Intracorporeal linear stapler side-to-side esophagojejunostomy. a One hole was created on the posterior wall of the esophageal stump. b The other hole was created on the antimesenteric side of the efferent jejunal. c Each jaw of the linear stapler was inserted into the holes on the esophageal stump and the jejunum, and then, the linear stapler fired. d The entry hole and esophagus were closed using staplers
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4837503&req=5

Fig3: Intracorporeal linear stapler side-to-side esophagojejunostomy. a One hole was created on the posterior wall of the esophageal stump. b The other hole was created on the antimesenteric side of the efferent jejunal. c Each jaw of the linear stapler was inserted into the holes on the esophageal stump and the jejunum, and then, the linear stapler fired. d The entry hole and esophagus were closed using staplers
Mentions: Mechanical stapler methods: conventional circular stapler-anvil method (type A): The stomach was lifted up, and a purse-string suture was placed at 1 cm above the predetermined transected line (Fig. 2a). A hole was made at the esophagogastric junction using the Harmonic scalpel. The anvil was introduced into the esophageal stump through the hole, and the purse-string suture was tied (Fig. 2b). The esophagogastric junction was divided, and the stomach was extracted. The circular stapler was introduced into the jejunum through the jejunal stump (Fig. 2c). The circular stapler attached with the anvil and fired (Fig. 2d). The jejunal stump was closed with endoscopic linear staplers. Linear stapler method (type B): A small opening was made 10 cm from the stump on the distal jejunum (Fig. 3a), and the latter was then pulled up to the esophagus, in which a small side opening was also made (Fig. 3b). A side-to-side antiperistaltic esophagojejunostomy was then performed using linear staplers (Fig. 3c), and then, the entry hole and esophagus were closed using staplers (Fig. 3d).Fig. 2

Bottom Line: For overall patients, the mean operation time and anastomotic time were 225.7 and 30.0 min, respectively.Postoperative complications were observed in 65 patients.All of the patients recovered well without perioperative death by conservative or surgical management.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 East Qing Chun Road, Hangzhou, 310016, Zhejiang Province, China.

ABSTRACT

Background: Totally laparoscopic gastrectomy (TLG) using intracorporeal anastomosis has gradually become mature thanks to the advancements of laparoscopic surgical instruments and the accumulation of operative experience. The goal of this study is to review our institution's experience with TLG for the treatment of gastric cancer.

Methods: A retrospective study was conducted to examine the short-term outcomes of TLG using intracorporeally stapler or hand-sewn anastomosis performed at Sir Run Run Shaw Hospital between March 2007 and June 2015. The details of intracorporeal anastomosis were described, and the clinicopathological data, surgical outcomes, and postoperative complications were evaluated.

Results: Four hundred seventy-eight patients were included in the study. Generally speaking, the patients could be divided into stapler or hand-sewn groups according to whether intracorporeal anastomosis was performed by only hand-sewn technique (n = 97) or only stapling devices (n = 381). For overall patients, the mean operation time and anastomotic time were 225.7 and 30.0 min, respectively. Postoperative complications were observed in 65 patients. All of the patients recovered well without perioperative death by conservative or surgical management.

Conclusions: TLG using intracorporeally stapler or hand-sewn anastomosis is a reasonable option for the treatment of gastric cancer, with early data showing acceptable perioperative outcomes.

No MeSH data available.


Related in: MedlinePlus