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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 hand-sewn end-to-side gastrojejunostomy. a Transection of the gastric stump with ultrasonic coagulating shears. b Suture of the posterior wall using interrupted sutures. c Suture of the anterior wall using a continuous suture. d Completed gastrojejunostomy
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Fig7: Intracorporeal hand-sewn end-to-side gastrojejunostomy. a Transection of the gastric stump with ultrasonic coagulating shears. b Suture of the posterior wall using interrupted sutures. c Suture of the anterior wall using a continuous suture. d Completed gastrojejunostomy

Mentions: Hand-sewn methods: gastrojejunostomy (Roux-en-Y, type F): A detachable laparoscopic intestinal clamp was placed at the greater curvature side of the gastric stump and transected with ultrasonic coagulating shears (Fig. 7a). The jejunal loop was introduced to approach the gastric stump. The details of hand-sewn gastrojejunostomy were similar to those of type C (Fig. 7b–d). Finally, a side-to-side jejunojejunostomy was performed through the enlarged umbilical incision. Gastroduodenostomy (Billroth I, type G): Two detachable laparoscopic intestinal clamps were placed at the pylorus and duodenum to avoid contamination. The duodenum was divided perpendicularly with ultrasonic coagulating shears between the two detachable clamps (Fig. 8a). The gastric stump was introduced to approach the duodenal stump. Then, several serosal muscularis interrupted sutures were made which are located at the rear part of the gastric and duodenal stump. A 3–4-cm-wide incision was made at the greater curvature side of the gastric stump for end-to-end gastroduodenostomy (Fig. 8b). The posterior wall of the esophagojejunostomy was sutured using interrupted sutures, and the anterior wall was sutured using a continuous suture (Fig. 8c). The seromuscular layer was strengthened with interrupted sutures to reduce tension (Fig. 8d). Gastrojejunostomy (Billroth II, type H): The jejunum loop 15 cm distal to the ligament of Treitz was introduced to approach the gastric stump. Then, several serosal muscularis interrupted sutures were made which are located at the rear part of the jejunum and gastric stump. A 3–4-cm-wide incision was made at the antimesenteric side of the jejunum for end-to-side gastrojejunostomy. The details of hand-sewn gastrojejunostomy were similar to those described above (Fig. 9).Fig. 7


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 hand-sewn end-to-side gastrojejunostomy. a Transection of the gastric stump with ultrasonic coagulating shears. b Suture of the posterior wall using interrupted sutures. c Suture of the anterior wall using a continuous suture. d Completed gastrojejunostomy
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig7: Intracorporeal hand-sewn end-to-side gastrojejunostomy. a Transection of the gastric stump with ultrasonic coagulating shears. b Suture of the posterior wall using interrupted sutures. c Suture of the anterior wall using a continuous suture. d Completed gastrojejunostomy
Mentions: Hand-sewn methods: gastrojejunostomy (Roux-en-Y, type F): A detachable laparoscopic intestinal clamp was placed at the greater curvature side of the gastric stump and transected with ultrasonic coagulating shears (Fig. 7a). The jejunal loop was introduced to approach the gastric stump. The details of hand-sewn gastrojejunostomy were similar to those of type C (Fig. 7b–d). Finally, a side-to-side jejunojejunostomy was performed through the enlarged umbilical incision. Gastroduodenostomy (Billroth I, type G): Two detachable laparoscopic intestinal clamps were placed at the pylorus and duodenum to avoid contamination. The duodenum was divided perpendicularly with ultrasonic coagulating shears between the two detachable clamps (Fig. 8a). The gastric stump was introduced to approach the duodenal stump. Then, several serosal muscularis interrupted sutures were made which are located at the rear part of the gastric and duodenal stump. A 3–4-cm-wide incision was made at the greater curvature side of the gastric stump for end-to-end gastroduodenostomy (Fig. 8b). The posterior wall of the esophagojejunostomy was sutured using interrupted sutures, and the anterior wall was sutured using a continuous suture (Fig. 8c). The seromuscular layer was strengthened with interrupted sutures to reduce tension (Fig. 8d). Gastrojejunostomy (Billroth II, type H): The jejunum loop 15 cm distal to the ligament of Treitz was introduced to approach the gastric stump. Then, several serosal muscularis interrupted sutures were made which are located at the rear part of the jejunum and gastric stump. A 3–4-cm-wide incision was made at the antimesenteric side of the jejunum for end-to-side gastrojejunostomy. The details of hand-sewn gastrojejunostomy were similar to those described above (Fig. 9).Fig. 7

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