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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

Linear stapler side-to-side gastrojejunostomy. a One hole was created on the posterior wall of the gastric stump. b The other hole was created on the antimesenteric side of the efferent jejunal. c Endoscopic linear stapler completing the anastomosis. d Laparoscopically closed common opening sewn by hand
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Fig6: Linear stapler side-to-side gastrojejunostomy. a One hole was created on the posterior wall of the gastric stump. b The other hole was created on the antimesenteric side of the efferent jejunal. c Endoscopic linear stapler completing the anastomosis. d Laparoscopically closed common opening sewn by hand

Mentions: Mechanical stapler methods: linear stapler delta-shaped method (Billroth I, type D): Small holes were then created along the edge of the gastric stump and duodenal stump (Fig. 5a). Then, they were approximated and joined with the endoscopic linear stapler (Fig. 5b). The staple line was then inspected for any defects, and hemostasis was verified. Stay sutures were placed to lift the common opening, which was then closed with two applications of the linear stapler (Fig. 5c, d). Linear stapler side-to-side method (Billroth II, type E): Two access openings were created: one on the posterior wall of the gastric stump 2 cm towards the cutting margin (Fig. 6a) and the other on the antimesenteric side of the efferent jejunal (15 cm distal to the ligament of Treitz) (Fig. 6b). One of the endoscopic linear stapler legs was inserted into the jejunum opening to draw the jejunum to the rear of the gastric stump. Then, the second leg was inserted into the stomach opening and fired (Fig. 6c). The common opening was closed with a continuous hand-sewn suture (Fig. 6d).Fig. 5


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)

Linear stapler side-to-side gastrojejunostomy. a One hole was created on the posterior wall of the gastric stump. b The other hole was created on the antimesenteric side of the efferent jejunal. c Endoscopic linear stapler completing the anastomosis. d Laparoscopically closed common opening sewn by hand
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig6: Linear stapler side-to-side gastrojejunostomy. a One hole was created on the posterior wall of the gastric stump. b The other hole was created on the antimesenteric side of the efferent jejunal. c Endoscopic linear stapler completing the anastomosis. d Laparoscopically closed common opening sewn by hand
Mentions: Mechanical stapler methods: linear stapler delta-shaped method (Billroth I, type D): Small holes were then created along the edge of the gastric stump and duodenal stump (Fig. 5a). Then, they were approximated and joined with the endoscopic linear stapler (Fig. 5b). The staple line was then inspected for any defects, and hemostasis was verified. Stay sutures were placed to lift the common opening, which was then closed with two applications of the linear stapler (Fig. 5c, d). Linear stapler side-to-side method (Billroth II, type E): Two access openings were created: one on the posterior wall of the gastric stump 2 cm towards the cutting margin (Fig. 6a) and the other on the antimesenteric side of the efferent jejunal (15 cm distal to the ligament of Treitz) (Fig. 6b). One of the endoscopic linear stapler legs was inserted into the jejunum opening to draw the jejunum to the rear of the gastric stump. Then, the second leg was inserted into the stomach opening and fired (Fig. 6c). The common opening was closed with a continuous hand-sewn suture (Fig. 6d).Fig. 5

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