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Kakinuma H, Honda M, Funo T, Mashiko R, Takano Y. Strangulated Bowel Obstruction Due to Hiatal Hernia After Laparoscopic Total Gastrectomy. Cureus 2024; 16:e58610. [PMID: 38644944 PMCID: PMC11031369 DOI: 10.7759/cureus.58610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 04/23/2024] Open
Abstract
Laparoscopic total gastrectomy results in more internal hernias than open surgery. However, there are few reports of incarcerated hiatal hernia after laparoscopic total gastrectomy. Here, we report a case of a 79-year-old male who underwent urgent surgical intervention for a strangulated intestinal obstruction due to an incarcerated hernia through the esophageal hiatus following laparoscopic total gastrectomy. In this case, an esophageal hiatal hernia was present before gastrectomy, but was not repaired. Additionally, the patient experienced significant weight loss after gastrectomy. Preoperative hiatal hernia and marked postoperative weight loss may pose risks.
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Affiliation(s)
- Hirohito Kakinuma
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, JPN
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, JPN
| | - Takumi Funo
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Koriyama, JPN
| | - Ryutaro Mashiko
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, JPN
| | - Yoshinao Takano
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, Southern Tohoku General Hospital, Koriyama, JPN
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Itamoto S, Fujikuni N, Tanabe K, Yanagawa S, Nakahara M, Noriyuki T. Hand-assisted laparoscopic surgery for an esophageal hiatal hernia with incarcerated transverse colon presenting after laparoscopic gastrectomy: a case report. Surg Case Rep 2023; 9:40. [PMID: 36939992 PMCID: PMC10027969 DOI: 10.1186/s40792-023-01621-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 03/12/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Esophageal hiatal hernia (EHH) presenting after gastrectomy for carcinoma is a type of internal hernia and very rare. There have been no published reports on the use of hand-assisted laparoscopic surgery (HALS) for the treatment of an incarcerated EHH that presented after a gastrectomy. Herein, we report a rare case of HALS performed for an incarcerated EHH presenting after a laparoscopic gastrectomy. CASE PRESENTATION This case report presents the case of a 66-year-old man who underwent hernia repair for an incarcerated hernia that presented after he underwent a laparoscopic proximal gastrectomy with double-tract reconstruction for cancer in the esophagogastric junction. Emergency laparoscopic hernia repair was performed and herniation of the transverse colon into the left thoracic cavity through a hiatal defect was confirmed. Since it was difficult to return the transverse colon into the abdominal cavity using forceps, the procedure was converted to HALS and the transverse colon was pulled back into the abdominal cavity. The hernia defect was closed using a non-absorbable suture. The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day. CONCLUSIONS The HALS approach provides the tactile experience of an open surgery combined with the benefits of a laparoscopic procedure such as good visualization and low invasiveness. In this case, when the transverse colon that had herniated into the left hemithorax was returned to the abdominal cavity, damage to the transverse colon was avoided by using the hand. Hence, HALS was safely performed to repair an incarcerated EHH after gastrectomy.
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Affiliation(s)
- Shingo Itamoto
- Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima, 722-8508, Japan
| | - Nobuaki Fujikuni
- Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima, 722-8508, Japan.
- Department of Gastroenterological Surgery, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Minami, Hiroshima, Hiroshima, 734-8530, Japan.
| | - Kazuaki Tanabe
- Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami, Hiroshima, Hiroshima, 734-8551, Japan
| | - Senichiro Yanagawa
- Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima, 722-8508, Japan
| | - Masahiro Nakahara
- Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima, 722-8508, Japan
| | - Toshio Noriyuki
- Department of Surgery, Onomichi General Hospital, 1-10-23 Hirahara, Onomichi, Hiroshima, 722-8508, Japan
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Wang Z, Liu X, Cheng Q, Wei Y, Li Z, Zhu G, Li Y, Wang K. Digestive tract reconstruction of laparoscopic total gastrectomy for gastric cancer: a comparison of the intracorporeal overlap, intracorporeal hand-sewn anastomosis, and extracorporeal anastomosis. J Gastrointest Oncol 2021; 12:1031-1041. [PMID: 34295554 DOI: 10.21037/jgo-21-231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/27/2021] [Indexed: 11/09/2022] Open
Abstract
Background The application of esophagojejunostomy has certain difficulties in totally laparoscopic total gastrectomy (TLTG). This is due to the higher requirement for surgical techniques and the lack of any unified standards. This study aim to explore the practicability and safety of intracorporeal overlap and intracorporeal hand-sewn anastomosis compared with extracorporeal anastomosis. Methods The clinical pathological data of 56 patients who underwent TLTG from March 2016 to December 2020 in the Harbin Medical University Cancer Hospital were retrospectively analyzed. According to the method of anastomosis, the patients were divided into the overlap (n=36) and the hand-sewn anastomosis (n=20). Patients who receive laparoscopic-assisted total gastrectomy (LATG; n=74) formed the control group. The basic clinical data, and intraoperative and postoperative results of the patients were assessed. Results Compared with the control group, the overlap anastomosis and hand-sewn anastomosis groups showed no significant differences in clinicopathological data and short-term postoperative recovery. There were no significant differences between the overlap and the control group in operation time nor anastomosis time. However, the anastomosis time of the hand-sewn anastomosis group was significantly prolonged compared to the control group (53.20±14.14 vs. 43.01±12.53 minutes, P=0.002). Compared with the control group, the operation cost was significantly higher in the overlap group (CNY 81,300±6,100 vs. CNY 76,600±6,800, P=0.001), but significantly lower in the hand-sewn anastomosis group (CNY 71,900±1,700 vs. CNY 76,600±6,800, P=0.003). Early postoperative complications occurred in 5 cases (13.9%) in the overlap group, 3 cases (15.0%) in the hand-sewn anastomosis group, and 11 cases (14.9%) in the control group. There were 3 cases (8.3%) of postoperative anastomotic-related complications in the overlap group. No anastomotic-related complications were observed in the hand-sewn anastomosis group. Conclusions The overlap anastomosis and hand-sewn anastomosis are practical and safe. Furthermore, the overlap anastomosis may be more suitable for patients with lower cardia and fundic lesions. The hand-sewn method has a wider range of indications pending advanced surgical skills, and is an effective supplementary technique for instrument anastomosis.
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Affiliation(s)
- Zeshen Wang
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Xirui Liu
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Qingqing Cheng
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yuzhe Wei
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Zhenglong Li
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Guanyu Zhu
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yanfeng Li
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Kuan Wang
- Department of Gastrointestinal Surgery, Harbin Medical University Cancer Hospital, Harbin, China
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Trans-hiatal herniation following esophagectomy or gastrectomy: retrospective single-center experiences with a potential surgical emergency. Hernia 2021; 26:259-278. [PMID: 33713205 PMCID: PMC8881432 DOI: 10.1007/s10029-021-02380-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 02/14/2021] [Indexed: 10/24/2022]
Abstract
PURPOSE Trans-hiatal herniation after esophago-gastric surgery is a potentially severe complication due to the risk of bowel incarceration and cardiac or respiratory complaints. However, measures for prevention and treatment options are based on a single surgeon´s experiences and small case series in the literature. METHODS Retrospective single-center analysis on patients who underwent surgical repair of trans-hiatal hernia following gastrectomy or esophagectomy from 01/2003 to 07/2020 regarding clinical symptoms, hernia characteristics, pre-operative imaging, hernia repair technique and perioperative outcome. RESULTS Trans-hiatal hernia repair was performed in 9 patients following abdomino-thoracic esophagectomy (40.9%), in 8 patients following trans-hiatal esophagectomy (36.4%) and in 5 patients following conventional gastrectomy (22.7%). Gastrointestinal symptoms with bowel obstruction and pain were mostly prevalent (63.6 and 59.1%, respectively), two patients were asymptomatic. Transverse colon (54.5%) and small intestine (77.3%) most frequently prolapsed into the left chest after esophagectomy (88.2%) and into the dorsal mediastinum after gastrectomy (60.0%). Half of the patients had signs of incarceration in pre-operative imaging, 10 patients underwent emergency surgery. However, bowel resection was only necessary in one patient. Hernia repair was performed by suture cruroplasty without (n = 12) or with mesh reinforcement (n = 5) or tension-free mesh interposition (n = 5). Postoperative pleural complications were most frequently observed, especially in patients who underwent any kind of mesh repair. Three patients developed recurrency, of whom two underwent again surgical repair. CONCLUSION Trans-hiatal herniation after esophago-gastric surgery is rare but relevant. The role of surgical repair in asymptomatic patients is disputed. However, early hernia repair prevents patients from severe complications. Measures for prevention and adequate closure techniques are not yet defined.
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Ezzy M, Heinz P, Kraus TW, Elshafei M. Incarcerated hiatal hernia - A rare postoperative complication following gastrectomy for stomach cancer. A case report and literature review. Int J Surg Case Rep 2021; 79:219-221. [PMID: 33485169 PMCID: PMC7820300 DOI: 10.1016/j.ijscr.2021.01.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 12/24/2022] Open
Abstract
Complicated hiatal hernia following gastrectomy for carcinoma is a rare surgical entity. The early diagnosis is often challenging, therefore, a high index of suspicion and an appropriate imaging diagnosis are paramount. Crural exploration and repair during primary surgery are recommended to avoid future revisional surgery.
Introduction Diaphragmatic complications following gastrostomies for gastric malignancies are extremely rare. The incidence of hiatal hernias after total gastrectomy for carcinoma is not well documented because of the poor prognosis associated with gastric cancer and the short life expectancy. Presentation of case This case report presents a 66-year-old male patient who developed an acute incarcerated hiatal hernia 8 month after total gastrectomy for gastric adenocarcinoma. The patient was found to have a herniated alimentary limb and dilated, incarcerated loops of the bowel through the 3.5-cm hiatal defect. The hernia was gently reduced. Posterior cruroplasty without mesh augmentation was performed with nonabsorbable sutures. The patient was discharged in good general condition. His history highlights an important and potentially morbid complication following gastrectomy. Discussion To our knowledge, only 5 cases have been reported in the literature. The incidence of symptomatic hiatal hernias following esophageal and gastric resection for carcinoma is 2.8%, and the median time between primary surgery and the diagnosis of hiatal hernias is 15 months. Conclusion During primary surgery, it is recommended, in the cases of pre-existing hiatal hernias or a crural dissection, to perform cruroplasty after adequate mobilization of the lower thoracic esophagus and a tension-free subdiaphragmatic anastomosis.
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Affiliation(s)
- Mohsen Ezzy
- Department of General and Minimal Invasive Surgery, Nordwest Hospital, Frankfurt 60488, Germany.
| | - Peter Heinz
- Department of General and Minimal Invasive Surgery, Nordwest Hospital, Frankfurt 60488, Germany.
| | - Thomas W Kraus
- Department of General and Minimal Invasive Surgery, Nordwest Hospital, Frankfurt 60488, Germany.
| | - Mostafa Elshafei
- Department of General and Minimal Invasive Surgery, Nordwest Hospital, Frankfurt 60488, Germany.
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Kamada T, Ohdaira H, Takeuchi H, Takahashi J, Marukuchi R, Ito E, Suzuki N, Narihiro S, Hoshimoto S, Yoshida M, Urashima M, Suzuki Y. Vertical distance from navel as a risk factor for bowel obstruction associated with feeding jejunostomy after esophagectomy: a retrospective cohort study. BMC Gastroenterol 2020; 20:354. [PMID: 33109092 PMCID: PMC7590660 DOI: 10.1186/s12876-020-01506-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022] Open
Abstract
Background Placement of feeding jejunostomy (PFJ) during esophagectomy is an effective method to maintain adequate nutrition, but is associated with serious complications such as bowel obstruction and jejunal torsion. The purpose of the current study was to analyze the incidence, clinical features, and risk factors of bowel obstruction associated with feeding jejunostomy (BOFJ) after PFJ. Methods This was a retrospective cohort study of 70 patients who underwent esophagectomy with three-field lymph node dissection for esophageal cancer and treated with PFJ between March 2013 and December 2019 in our hospital. Abdominal dissection was performed under hand-assisted laparoscopic surgery (HALS) from March 2013 to March 2015, and was changed to complete laparoscopic surgery in April 2015. We compared patients with and without BOFJ, and the incidence of BOFJ was evaluated. The primary endpoint was incidence of BOFJ after PFJ. Results Six patients (8.5%) were diagnosed with BOFJ, all of whom were symptomatic and in the HALS group. In addition, 3 cases displayed histories of recurrent BOFJ (3, 3, and 5 times). Laparotomy was performed in all cases. Subgroup analysis of the HALS group showed a significant difference only in straight-line distance between the jejunostomy and navel as a significant pre- and perioperative factor (117 mm [101–130 mm] vs. 89 mm [51–150 mm], p < 0.001). Furthermore, dividing straight-line distance between the jejunostomy and navel into VD and HD, only VD differed significantly (107 mm [93–120 mm] vs. 79 mm [28–135 mm], p = 0.010), not HD (48 mm [40–59 mm] vs. 46 mm [22–60 mm], p = 0.199). Conclusions VD between the jejunostomy and navel was associated with BOFJ after PFJ with HALS esophagectomy. PFJ < 9 cm above the navel during HALS esophagectomy might effectively prevent BOFJ.
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Affiliation(s)
- Teppei Kamada
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan.
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
| | - Hideyuki Takeuchi
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
| | - Junji Takahashi
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
| | - Rui Marukuchi
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
| | - Eisaku Ito
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
| | - Norihiko Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
| | - Satoshi Narihiro
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
| | - Sojun Hoshimoto
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
| | - Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
| | - Mitsuyoshi Urashima
- Division of Molecular Epidemiology, Jikei University School of Medicine, Tokyo, Japan
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, Nasushiobara City, Tochigi, 537-3, Iguchi329-2763, Japan
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Gallyamov EA, Agapov MA, Donchenko KA, Gallyamov EE, Kakotkin VV. [Comparison of efficiency and safety of laparoscopic manual esophagoenterostomy and esophagoenterostomy with mechanical anastomotic devices after laparoscopic gastrectomy for stomach cancer]. Khirurgiia (Mosk) 2020:11-17. [PMID: 32352662 DOI: 10.17116/hirurgia202004111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To compare laparoscopic manual esophagoenterostomy and esophagoenterostomy with mechanical stapling anastomotic devices after laparoscopic gastrectomy for stomach cancer. MATERIAL AND METHODS There were 34 patients who underwent laparoscopic gastrectomy for stomach in 2015-2018. Roux-en-Y esophagoenterostomy was used to reconstruct the gastrointestinal tract. Manual anastomoses were performed in 18 patients (group 1), stapled anastomoses (endogia 45 mm, covidien, mansfield, ma, usa) - in 16 patients (group 2). There was no randomization. Surgery duration, length of icu-stay, terms of enteral nutrition initiation, postoperative complications, hospital-stay were analyzed. RESULTS Mean duration of surgery in the first group was 217 (184-302) min, in the second group - 201 (162-311) min. Duration of surgery in the first group was 1.08-fold higher than in the second group (95% CI 1.03-1.13, p=0.05). Mean blood loss was 145 ml in both groups. Mean icu-stay was 20.2 (17-42) hours in the first group and 21.1 (16.2-46) hours in the second group (ratio 0.96, 95% CI 0.92-1.01, p=0.06). Total enteral feeding (sipping) was initiated on the third day in both groups. Mean postoperative hospital-stay was 9.21 (6-13) days in the first group and 9.23 (6-12 days) days in the second group (ratio 0.99, 95% CI 0,95-1.02, p=0.06). Postoperative morbidity was 5.5% in the first group and 6.25% in the second group. CONCLUSION Laparoscopic manual esophagoenterostomy proposed by our surgical team does not have disadvantages in comparison with stapling anastomotic devices and these methods may be alternative to each other.
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Affiliation(s)
- E A Gallyamov
- Sechenov First Moscow State Medical University of the Ministry of Health of Russia (Sechenov University), Moscow, Russia
| | - M A Agapov
- Lomonosov Moscow State University, Faculty of Fundamental Medicine, Moscow, Russia
| | - K A Donchenko
- Lomonosov Moscow State University, Faculty of Fundamental Medicine, Moscow, Russia
| | - E E Gallyamov
- Federal Medical and Biological Agency of Russia, Moscow, Russia
| | - V V Kakotkin
- Lomonosov Moscow State University, Faculty of Fundamental Medicine, Moscow, Russia
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Thoracoscopic revision of a herniated Roux-en-Y esophagojejunostomy for treatment of "candy cane" syndrome. JTCVS Tech 2020; 2:153-155. [PMID: 34317787 PMCID: PMC8298848 DOI: 10.1016/j.xjtc.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/02/2020] [Indexed: 11/20/2022] Open
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Diaphragmatic Hernia After Totally Laparoscopic Total Gastrectomy for Gastric Cancer. Surg Laparosc Endosc Percutan Tech 2019; 29:194-199. [PMID: 30720695 DOI: 10.1097/sle.0000000000000638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This study aimed to investigate the occurrence of diaphragmatic hernia (DH) after totally laparoscopic total gastrectomy (TLTG) for gastric cancer. We reviewed retrospectively collected data from 490 consecutive patients who underwent TLTG (functional method, 365; overlap method, 125) for upper body gastric cancer, between January 2011 and May 2017, performed by a single surgeon. The median follow-up period was 40.6 months. Of 490 patients, 8 (1.63%) developed DH at a mean interval after TLTG of 7.3 (range, 3.4 to 12.8) months. All 8 patients were from the functional group, and presented with abdominal pain or vomiting. They were managed with emergency surgery (5 laparoscopic hernia reduction, 3 open hernia reduction). The grade of complication according to Clavien-Dindo classification (CDC) was CDC-III in 7 cases and CDC-IV in 1 case. There was no death associated with DH complications. None of the patients in the overlap group developed DH. The incidence of DH after TLTG is negligible in the overlap method. Therefore, the overlap method may be a safe reconstruction technique that can reduce the occurrence of DC after TLTG for gastric cancer.
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Diaphragmatic herniation following total gastrectomy: review of the long-term experience of a tertiary institution. Langenbecks Arch Surg 2019; 404:993-998. [PMID: 31745625 DOI: 10.1007/s00423-019-01842-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 11/10/2019] [Indexed: 12/24/2022]
Abstract
PURPOSE Diaphragmatic herniation (DH) is a rare but potentially fatal event after total gastrectomy (TG). Despite being life-threatening, risk factors for postoperative DH have yet to be elucidated. We conducted a retrospective analysis to identify clinical characteristics of patients developing DH after TG, along with a comprehensive review of the published literature. METHODS Among 1361 consecutive patients undergoing TG for esophagogastric cancer between 1985 and 2013 in Toranomon Hospital, those requiring surgical intervention for postoperative DH were included. We also conducted a PubMed literature search on DH following TG. RESULTS Five patients (four males, one female), with a median age of 68 at DH surgery, were identified. Intervals between TG and DH repair ranged from 2.9 to 189.0 (median, 78.1) months. Four patients had needed emergency surgery. Three patients had undergone open TG and two others laparoscopic TG, suggesting a significantly higher incidence of DH after laparoscopic TG (3/1302 vs. 2/59, p = 0.017). The diaphragmatic crus incision, creating the space for esophagojejunostomy, had been performed in all cases. The literature yielded seven relevant publications (16 patients). Intervals between TG and DH reduction ranged from 2 days to 36 months. All operations for DH had been carried out emergently. CONCLUSION The risk of DH persisted after TG. DH is potentially a very late complication of TG, presenting as a surgical emergency. Laparoscopic TG was suggested to be a risk factor for postgastrectomy DH. Incising the crus might also be a predictor of DH. Measures to prevent DH, e.g., appropriate closure of the crus, would be recommended in minimally invasive TG.
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Kawaguchi Y, Shiraishi K, Akaike H, Ichikawa D. Current status of laparoscopic total gastrectomy. Ann Gastroenterol Surg 2019; 3:14-23. [PMID: 30697606 PMCID: PMC6345655 DOI: 10.1002/ags3.12208] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/12/2018] [Accepted: 08/14/2018] [Indexed: 12/13/2022] Open
Abstract
In this article, the current state of laparoscopic total gastrectomy (LTG) was reviewed, focusing on lymph node dissection and reconstruction. Lymph node dissection in LTG is technically similar to that in laparoscopic distal gastrectomy for early gastric cancer; however, LTG for advanced gastric cancer requires extended lymph node dissections including splenic hilar lymph nodes. Although a recent randomized controlled trial clearly indicated no survival benefit in prophylactic splenectomy for lymph node dissection at the splenic hilum, some patients may receive prognostic benefit from adequate splenic hilar lymph node dissection. Considering reconstruction, there are two major esophagojejunostomy (EJS) techniques, using a circular stapler (CS) or using a linear stapler (LS). A few studies have shown that the LS method has fewer complications; however, almost all studies have reported that morbidity (such as anastomotic leakage and stricture) is not significantly different for the two methods. As for CS, we grouped various studies addressing complications in LTG into categories according to the insertion procedure of the anvil and the insertion site in the abdominal wall for the CS. We compared the rate of complications, particularly for leakage and stricture. The rate of anastomotic leakage and stricture was the lowest when inserting the CS from the upper left abdomen and was significantly the highest when inserting the CS from the midline umbilical. Scrupulous attention to EJS techniques is required by surgeons with a clear understanding of the advantages and disadvantages of each anastomotic device and approach.
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Affiliation(s)
- Yoshihiko Kawaguchi
- First Department of SurgeryFaculty of MedicineUniversity of YamanashiChuoYamanashiJapan
| | - Kensuke Shiraishi
- First Department of SurgeryFaculty of MedicineUniversity of YamanashiChuoYamanashiJapan
| | - Hidenori Akaike
- First Department of SurgeryFaculty of MedicineUniversity of YamanashiChuoYamanashiJapan
| | - Daisuke Ichikawa
- First Department of SurgeryFaculty of MedicineUniversity of YamanashiChuoYamanashiJapan
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Barnett DR, Cockbain AJ, Shenfine J, Thompson SK. Double trouble: two sites of internal hernia following total gastrectomy. ANZ J Surg 2018; 89:1497-1498. [PMID: 30362219 DOI: 10.1111/ans.14913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/14/2018] [Accepted: 09/18/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Dylan R Barnett
- Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Andrew J Cockbain
- Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jon Shenfine
- Discipline of Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Sarah K Thompson
- Discipline of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Esophagojejunostomy With Linear Staplers in Laparoscopic Total Gastrectomy: Experience With 168 Cases in 5 Consecutive Years. Surg Laparosc Endosc Percutan Tech 2018; 27:e101-e107. [PMID: 28902037 DOI: 10.1097/sle.0000000000000464] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE We evaluate surgical outcomes of intracorporeal esophagojejunostomy in laparoscopic total gastrectomy using 2 linear stapler methods. MATERIALS AND METHODS The functional end-to-end anastomosis (FEEA) method was chosen as a first choice. The overlap method was chosen in cases with esophageal invasion. We retrospectively analyzed the early and late surgical outcomes of consecutive 168 laparoscopic total gastrectomy cases from April 2011 to December 2016. RESULTS AND CONCLUSIONS The FEEA method was selected in 120 cases, and the overlap method was selected in 48 cases. The mean time of esophagojejunostomy for the FEEA and overlap method was 13.2 and 36.5 minutes, respectively. Two cases with FEEA method and 3 cases with overlap method experienced complications due to esophagojejunostomy leakage. These cases were treated without performing a reoperation. One case with FEEA method was complicated due to esophagojejunostomy stenosis. This case was endoscopically treated. Our procedures are safe and feasible.
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