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Sano A, Imai Y, Yamaguchi T, Bamba T, Shinno N, Kawashima Y, Tokunaga M, Enokida Y, Tsukada T, Hatakeyama S, Koga T, Kuwabara S, Urakawa N, Arai J, Yamamoto M, Yasufuku I, Iwasaki H, Sakon M, Honboh T, Kawaguchi Y, Kusumoto T, Shibao K, Hiki N, Nakazawa N, Sakai M, Sohda M, Shirabe K, Oki E, Baba H, Saeki H. Importance of duodenal stump reinforcement to prevent stump leakage after gastrectomy: a large-scale multicenter retrospective study (KSCC DELICATE study). Gastric Cancer 2024:10.1007/s10120-024-01538-x. [PMID: 39028419 DOI: 10.1007/s10120-024-01538-x] [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: 05/09/2024] [Accepted: 07/12/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND The significance of reinforcement of the duodenal stump with seromuscular sutures and the effectiveness of reinforced staplers in preventing duodenal stump leakage remain unclear. We aimed to explore the importance of duodenal stump reinforcement and determine the optimal reinforcement method for preventing duodenal stump leakage. METHODS This retrospective cohort study was conducted between January 1, 2012 and December 31, 2021, with data analyzed between December 1, 2022 and September 30, 2023. This multicenter study across 57 institutes in Japan included 16,475 patients with gastric cancer who underwent radical gastrectomies. Elective open or minimally invasive (laparoscopic or robotic) gastrectomy was performed in patients with gastric cancer. RESULTS Duodenal stump leakage occurred in 153 (0.93%) of 16,475 patients. The proportions of males, patients aged ≥ 75 years, and ≥ pN1 were higher in patients with duodenal stump leakage than in those without duodenal stump leakage. The incidence of duodenal stump leakage was significantly lower in the group treated with reinforcement by seromuscular sutures or using reinforced stapler than in the group without reinforcement (0.72% vs. 1.19%, p = 0.002). Duodenal stump leakage incidence was also significantly lower in high-volume institutions than in low-volume institutions (0.70% vs. 1.65%, p = 0.047). The rate of duodenal stump leakage-related mortality was 7.8% (12/153). In the multivariate analysis, preoperative asthma and duodenal invasion were identified as independent preoperative risk factors for duodenal stump leakage-related mortality. CONCLUSIONS The duodenal stump should be reinforced to prevent duodenal stump leakage after radical gastrectomy in patients with gastric cancer.
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Affiliation(s)
- Akihiko Sano
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Yoshiro Imai
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Takahisa Yamaguchi
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Takeo Bamba
- Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Naoki Shinno
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yoshiyuki Kawashima
- Department of Gastroenterological Surgery, Saitama Cancer Center, Ina-Machi, Japan
| | - Masanori Tokunaga
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuaki Enokida
- Department of Gastroenterological Surgery, Gunma Prefectural Cancer Center, Ota, Japan
| | - Tomoya Tsukada
- Department of Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Satoru Hatakeyama
- Department of Surgery, Niigata Prefectural Shibata Hospital, Shibata, Japan
| | - Tadashi Koga
- Department of Surgery, Iizuka Hospital, Iizuka, Japan
| | - Shirou Kuwabara
- Department of Digestive Surgery, Niigata City General Hospital, Niigata, Japan
| | - Naoki Urakawa
- Department of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junichi Arai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, Nagasaki, Japan
| | - Manabu Yamamoto
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Itaru Yasufuku
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hironori Iwasaki
- Department of Surgery, Japanese Red Cross Kumamoto Hospital, Kumamoto, Japan
| | - Masahiro Sakon
- Department of Digestive Surgery, Nagano Municipal Hospital, Nagano, Japan
| | - Takuya Honboh
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Yoshihiko Kawaguchi
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | - Tetsuya Kusumoto
- Department of Gastroenterological Surgery, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Kazunori Shibao
- Department of Surgery I, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
| | - Naoki Hiki
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Nobuhiro Nakazawa
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Makoto Sakai
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Makoto Sohda
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan
| | - Hiroshi Saeki
- Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
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Liu X, Kong W, Ying R, Shan Y, Yin G. Reinforcement methods of duodenal stump after laparoscopic gastrectomy for gastric cancer: A review. Heliyon 2023; 9:e17272. [PMID: 37360094 PMCID: PMC10285238 DOI: 10.1016/j.heliyon.2023.e17272] [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: 04/25/2022] [Revised: 05/23/2023] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Duodenal stump fistula is a rare but dangerous complication of gastric cancer surgery. Reinforcement of the duodenal stump was suggested as a useful method to prevent the occurrence of duodenal stump fistula. Although laparoscopic surgery has been established as a safe procedure for gastric cancer, it is acknowledged that the application of duodenal stump reinforcement is a demanding process in laparoscopic radical gastrectomy. This review aims to provide a concise description of the proposed reinforcement methods of duodenal stump after laparoscopic radical gastrectomy for gastric cancer by summarizing the relevant literature written in English. The thorough knowledge of these reinforcement techniques may help surgeons to find the most suitable reinforcement method of duodenal stump for patients.
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Affiliation(s)
| | | | | | | | - Guang Yin
- Corresponding author. Department of Gastrointestinal Surgery, Zhejiang University School of Medicine, Hangzhou, China.
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Iino I, Kikuchi H, Suzuki T, Kawabata T, Jindo O, Uno A, Fukazawa A, Matsumoto K, Ochiai H, Sakaguchi T, Takeuchi H, Konno H, Suzuki S. Comprehensive evaluation of three-dimensional anatomy of perigastric vessels using enhanced multidetector-row computed tomography. BMC Surg 2022; 22:403. [PMID: 36404317 PMCID: PMC9677658 DOI: 10.1186/s12893-022-01836-0] [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] [Received: 04/26/2022] [Accepted: 11/03/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND To perform laparoscopic gastrectomy safely, we aimed to comprehensively re-evaluate perigastric vessel anatomies using a three-dimensional angiography reconstructed from enhanced multidetector-row computed tomography data. METHODS Perigastric vessel anatomy was preoperatively analyzed using a multidetector-row computed tomography-based three-dimensional angiography reconstructed in 127 patients undergoing gastric surgery. RESULTS Of the 67 left gastric veins that ran along the dorsal side of the arteries, 59 (88.1%) ran along the dorsal side of the common hepatic artery and flowed into the portal vein. In 18 cases, a common trunk of one to three left gastric arteries and the replaced left hepatic artery was observed. The left inferior phrenic artery ramified from the left gastric artery in 5.5% of the cases. The right gastric artery was classified into distal (73.2%), caudal (18.1%), and proximal (8.7%) types. The infra-pyloric artery was also classified into distal (64.6%), caudal (26.0%), and proximal (9.4%) types. The posterior gastric artery branched as a common trunk with the superior polar artery in the proximal (37.9%) and distal (18.4%) regions of the splenic artery. The left gastroepiploic artery ramified from the splenic (18.1%) and inferior terminal arteries (81.9%). No, one, and two gastric branches of the left gastroepiploic artery, which ramified between the roots of the left gastroepiploic artery and its omental branch, were found in 36.5%, 49.2%, and 14.3% of the cases, respectively. CONCLUSIONS Preoperative 3D angiography is useful for the precise evaluation of perigastric vessel anatomies, and may help us to perform laparoscopic gastrectomy and robotic surgery safely.
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Affiliation(s)
- Ichirota Iino
- grid.414861.e0000 0004 0378 2386Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan
| | - Hirotoshi Kikuchi
- grid.505613.40000 0000 8937 6696Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192 Japan
| | - Toshiyuki Suzuki
- grid.414861.e0000 0004 0378 2386Department of Radiological Technology, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan
| | - Toshiki Kawabata
- grid.414861.e0000 0004 0378 2386Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan
| | - Osamu Jindo
- grid.414861.e0000 0004 0378 2386Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan
| | - Akihiro Uno
- grid.414861.e0000 0004 0378 2386Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan
| | - Atsuko Fukazawa
- grid.414861.e0000 0004 0378 2386Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan
| | - Keigo Matsumoto
- grid.414861.e0000 0004 0378 2386Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan
| | - Hideto Ochiai
- grid.414861.e0000 0004 0378 2386Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan
| | - Takanori Sakaguchi
- grid.414861.e0000 0004 0378 2386Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan ,grid.505613.40000 0000 8937 6696Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192 Japan
| | - Hiroya Takeuchi
- grid.505613.40000 0000 8937 6696Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192 Japan
| | - Hiroyuki Konno
- grid.505613.40000 0000 8937 6696Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192 Japan
| | - Shohachi Suzuki
- grid.414861.e0000 0004 0378 2386Department of Surgery, Iwata City Hospital, 512-3 Okubo, Iwata, 438-8550 Japan
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Cai Z, Song H, Huang Z, Fingerhut A, Xu X, Zhong H, Li Z, Zhang Y, Sha D, Bao D, Wang H, Cai B, Hua S, Zhang Y, Sun J, Ye K, Li J, Lu Y, Feng B. Safety and feasibility of laparoscopic surgery for colorectal and gastric cancer under the Chinese multi-site practice policy: admittance standards of competence are needed. Gastroenterol Rep (Oxf) 2022; 10:goac046. [PMID: 36196254 PMCID: PMC9522381 DOI: 10.1093/gastro/goac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/02/2022] [Accepted: 08/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background The multi-site practice (MSP) policy has been practiced in China over 10 years. This study aimed to investigate the safety and feasibility of performing laparoscopic surgery for colorectal cancer (LSCRC) and gastric cancer (LSGC) under the Chinese MSP policy. Methods We collected and analysed the data from 1,081 patients who underwent LSCRC or LSGC performed by one gastrointestinal surgeon in his original hospital (n = 573) and his MSP institutions (n = 508) between January 2017 and December 2020. Baseline demographics, intraoperative outcomes, post-operative recovery, and pathological results were compared between the original hospital and MSP institutions, as well as between MSP institutions with and without specific competence (surgical skill, operative instrument, perioperative multi-discipline team). Results In our study, 690 patients underwent LSCRC and 391 patients underwent LSGC. The prevalence of post-operative complications was comparable for LSCRC (11.5% vs 11.1%, P = 0.89) or LSGC (15.2% vs 12.6%, P = 0.46) between the original hospital and MSP institutions. However, patients in MSP institutions without qualified surgical assistant(s) and adequate instruments experienced longer operative time and greater intraoperative blood loss. The proportion of patients with inadequate lymph-node yield was significantly higher in MSP institutions than in the original hospital for both LSCRC (11.5% vs 21.2%, P < 0.01) and LSGC (9.8% vs 20.5%, P < 0.01). Conclusion For an experienced gastrointestinal surgeon, performing LSCRC and LSGC outside his original hospital under the MSP policy is safe and feasible, but relies on the precondition that the MSP institutions are equipped with qualified surgical skills, adequate operative instruments, and complete perioperative management.
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Affiliation(s)
| | | | | | - Abraham Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China
- Section for Surgical Research, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Ximo Xu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China
| | - Hao Zhong
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P. R. China
- Shanghai Minimally Invasive Surgery Center, Shanghai, P. R. China
| | - Zhigang Li
- Department of General Surgery, Wuxi Huishan District People’s Hospital, Jiangsu, P. R. China
| | - Yingjie Zhang
- Department of General Surgery, Zhoushan Hospital, Zhejiang, P. R. China
| | - Dachong Sha
- Department of General Surgery, Cixi Third People’s Hospital, Zhejiang, P. R. China
| | - Dandan Bao
- Department of General Surgery, People’s Hospital of Wenzhou, Zhejiang, P. R. China
| | - Haibo Wang
- Department of General Surgery, Chinese PLA 107 Hospital, Shandong, P. R. China
| | - Binghua Cai
- Department of General Surgery, Rudong People’s Hospital, Jiangsu, P. R. China
| | - Shangbo Hua
- Department of General Surgery, Kunshan Hospital of Chinese Medicine, Jiangsu, P. R. China
| | - Yanhui Zhang
- Department of General Surgery, Jingjiang Chinese Medicine Hospital, Jiangsu, P. R. China
| | - Jianguang Sun
- Department of General Surgery, Haiyan People’s Hospital, Zhejiang, P. R. China
| | - Ke Ye
- Department of General Surgery, Yueqing People’s Hospital, Zhejiang, P. R. China
| | - Jianwen Li
- Corresponding author. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No. 197 Ruijin Er Road, Shanghai 200025, P. R. China. Tel: +86-21-64370045; ; Department of Medical Affairs, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No. 197 Ruijin Er Road, Shanghai 200025, P. R. China; Tel: +86-21-64370045; ; Shanghai Minimally Invasive Surgery Center, No. 197 Ruijin Er Road, Shanghai 200025, P. R. China. Tel: +86-21-64458887;
| | - Yong Lu
- Corresponding author. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No. 197 Ruijin Er Road, Shanghai 200025, P. R. China. Tel: +86-21-64370045; ; Department of Medical Affairs, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No. 197 Ruijin Er Road, Shanghai 200025, P. R. China; Tel: +86-21-64370045; ; Shanghai Minimally Invasive Surgery Center, No. 197 Ruijin Er Road, Shanghai 200025, P. R. China. Tel: +86-21-64458887;
| | - Bo Feng
- Corresponding author. Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No. 197 Ruijin Er Road, Shanghai 200025, P. R. China. Tel: +86-21-64370045; ; Department of Medical Affairs, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine. No. 197 Ruijin Er Road, Shanghai 200025, P. R. China; Tel: +86-21-64370045; ; Shanghai Minimally Invasive Surgery Center, No. 197 Ruijin Er Road, Shanghai 200025, P. R. China. Tel: +86-21-64458887;
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Yang R, Yang Y, Chen X, Yang Q. A Novel Technique for Extracorporeal Anastomosis: The Bronchus Forceps Is Applied to Reinforce the Esophageal Ring. J Laparoendosc Adv Surg Tech A 2021; 31:1315-1320. [PMID: 34129399 DOI: 10.1089/lap.2021.0233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: For laparoscopic gastrectomy, it is significant to reduce the incidence of anastomotic leakage. The authors develop a novel technique for safe extracorporeal anastomosis that employs the bronchus forceps to reinforce the esophageal ring. Methods: From January 2017 to July 2020, 173 consecutive patients with gastric cancer received laparoscopic total gastrectomy or laparoscopic proximal gastrectomy. One hundred thirty-one patients only underwent extracorporeal anastomosis with a purse-string suture instrument (PSI) and a 25 mm circular stapler (Ethicon Intraluminal Circular Staplers CDH25A, Ethicon) (Conventional Surgery Group). In addition to these tools for extracorporeal anastomosis, the surgeon creatively used bronchus forceps to reinforce the esophageal ring on the anvil of circular stapler in 42 patients (Bronchus Forceps Ligation Group). The condition and the mean diameter of the narrowest part of the esophageal rings, postoperative outcomes, and complications were compared between the two groups. Results: Under direct vision, the esophageal rings were more complete in the Bronchus Forceps Ligation Group. Furthermore, the mean diameter of the narrowest part of the esophageal rings in the Bronchus Forceps Ligation Group was wider than that in the Conventional Surgery Group (4.34 ± 0.84 versus 2.68 ± 0.74 mm; P < .001). Meanwhile, the incidence of anastomotic leakage was lower in the Bronchus Forceps Ligation Group. Although reinforcing the anvil with the bronchus forceps will add additional surgery time, almost all can be done in less than 5 minutes. Conclusions: With applying the bronchus forceps to reinforce the esophageal ring on the anvil of the circular stapler, the extracorporeal anastomosis can be performed more safely.
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Affiliation(s)
- Rui Yang
- Department of the General Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yuyi Yang
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Xuan Chen
- Department of the General Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qingqiang Yang
- Department of the General Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Inamoto S, Obama K, Asai S, Mizuno R, Itatani Y, Hashimoto K, Hisamori S, Tsunoda S, Hida K, Kawada K, Sakai Y. Laparoscopic distal gastrectomy for gastric cancer patient with intestinal malrotation: report of a case. Surg Case Rep 2019; 5:45. [PMID: 30911866 PMCID: PMC6433996 DOI: 10.1186/s40792-019-0606-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/15/2019] [Indexed: 12/18/2022] Open
Abstract
Background Intestinal malrotation, which arises from incomplete rotation of the embryonic midgut, is one of the congenital anomalies usually diagnosed in infancy. On the other hand, intestinal malrotation detected in asymptomatic adults is very rare. It is frequently diagnosed incidentally during abdominal surgery. We report a case of asymptomatic intestinal malrotation diagnosed during laparoscopic distal gastrectomy for gastric cancer. Case presentation A 59-year-old female was diagnosed with early-stage gastric cancer during health screening and admitted to our hospital for radical surgical treatment. Physical examinations and blood tests revealed nothing of note. The type 0-IIc gastric cancer was located in the posterior wall of the mid-body of the stomach. The histological type was poorly differentiated adenocarcinoma. Esophagogastroduodenoscopy and computed tomography (CT) suggested that the depth of tumor invasion was the submucosal layer without regional lymph node swelling. The clinical stage according to the TNM 7th edition was cT1b N0 M0, cStage I. Laparoscopic distal gastrectomy with D1+ lymph node dissection and Billroth-I method reconstruction was planned. During the infrapyloric lymph node dissection, a part of the pancreatic head showed unusual adherence to the first part of the duodenal wall. For safe and accurate lymphadenectomy while avoiding pancreatic injury, we deliberately focused on tracing the dissectible layer between the pancreatic parenchyma and fatty tissues including lymph nodes. Also, we changed the reconstruction procedure from Billroth-I to Roux-en-Y. After distal gastrostomy, we could not find the ligament of Treitz or jejunum on the left side below the transverse colon. Based on a review of the CT image, this patient was diagnosed with intestinal malrotation. Although the detection of malrotation during the operation was incidental, we could complete radical surgery and Roux-en-Y reconstruction safely. The type of malrotation was non-rotation (90°). She was discharged from our hospital without any complications. Conclusion We encountered a case of adult asymptomatic intestinal malrotation with gastric cancer. Even when encountering such a case during laparoscopic gastrectomy, reviewing CT images carefully to reconsider the anatomical anomalies, and tracing the dissectible layer accurately with adequate countertraction can facilitate safe and successful surgery.
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Affiliation(s)
- Susumu Inamoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kazutaka Obama
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Satsuki Asai
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Rei Mizuno
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshiro Itatani
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kyoichi Hashimoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shigeo Hisamori
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shigeru Tsunoda
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Koya Hida
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kenji Kawada
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin- Kawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Misawa K, Yoshikawa T, Ito S, Cho H, Ito Y, Ogata T. Safety and Feasibility of Linear Stapling Device with Bioabsorbable Polyglycolic Acid Sheet for Duodenal Closure in Gastric Cancer Surgery: A Multi-institutional Phase II Study. World J Surg 2019; 43:192-198. [PMID: 30105634 DOI: 10.1007/s00268-018-4748-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Duodenal stump fistula (DSF) after gastrectomy is of low frequency but a critical complication in gastric cancer surgery. Manual oversewing for reinforcement of the duodenal stump is not applicable when free longitudinal margin is short and has technical difficulties in laparoscopic surgery. This trial evaluated the safety and feasibility of using a linear stapler with bioabsorbable polyglycolic acid (PGA) sheet for duodenal stump closure and reinforcement in gastric cancer surgery. METHODS This multi-institutional, prospective phase II trial included gastric cancer patients who were scheduled to undergo distal or total gastrectomy with R-Y reconstruction. In all cases, duodenum was transected using a linear stapler with PGA sheet. The primary endpoint was the incidence of postoperative DSF. Sample size was set at 100 patients considering an expected value of 3% and threshold value of 8% with one-sided testing at a 10% significance level. RESULTS Between June 2014 and June 2015, a total of 100 patients were registered in this trial. Postoperative DSF was observed in two cases (2.0%, 90% CI 0.4-6.2%) which was developed on postoperative days 13 and 20. Intraoperative bleeding at the duodenal stump staple line was observed in one case but was easily controlled without additional suturing. Postoperative bleeding was not observed in any of the cases. CONCLUSION This study suggested that the use of PGA sheet as a reinforcement material for closure of the duodenal stump during gastrectomy for gastric cancer is both safe and feasible. Trial registration number UMIN 000014398.
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Affiliation(s)
- Kazunari Misawa
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-Ku, Nagoya, 464-8681, Japan.
| | - Takaki Yoshikawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-Ku, Yokohama, 241-0815, Japan
| | - Seiji Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-Ku, Nagoya, 464-8681, Japan
| | - Haruhiko Cho
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-Ku, Yokohama, 241-0815, Japan
| | - Yuichi Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-Ku, Nagoya, 464-8681, Japan
| | - Takashi Ogata
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-Ku, Yokohama, 241-0815, Japan
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Rino Y, Yukawa N, Kano K, Sato T, Yamada T, Aoyama T, Maezawa Y, Oshima T, Shiozawa M, Morinaga S, Cho H, Yoshikawa T, Masuda M. Our connection procedure for an EEA™ XL stapler and anvil head using EEA OrVil™ for laparoscopic total or proximal gastrectomy. Asian J Endosc Surg 2018; 11:280-283. [PMID: 30129711 DOI: 10.1111/ases.12446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 10/24/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We describe an easy technique to connect the anvil and center rod of the EEA™ OrVil™. MATERIALS AND SURGICAL TECHNIQUE The bulb tip of EEA OrVil was orally inserted slowly until the valve tip reached the esophageal stump. The surgeon inserted forceps while grasping the anvil from the right abdomen trocar. The circular stapler (EEA XL) was inserted via the cut-off stump of the lifted jejunum or remnant stomach through the intraumbilical incision. Then, the circular stapler was held with the shaft convex. When the automated stapler and center rod were confirmed to be completely aligned, the anvil and the main unit were connected, and the device was fired. DISCUSSION Although we only reversed the direction of the circular stapler's shaft, this method improved the ease of the operation.
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Affiliation(s)
- Yasushi Rino
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Norio Yukawa
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazuki Kano
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Tsutomu Sato
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Takanobu Yamada
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Toru Aoyama
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Yukio Maezawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Takashi Oshima
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Manabu Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Soichiro Morinaga
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Haruhiko Cho
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Takaki Yoshikawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
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