Novel abdominal negative pressure lavage-drainage system for anastomotic leakage after R0 resection for gastric cancer

Short-term outcomes of a new gastrointestinal decompression tube combined with conservative treatment in patients with esophagojejunal anastomotic leakage after total gastrectomy

To compare the short-term outcomes of a new gastrointestinal decompression tube combined with conservative treatment in patients with esophagojejunal anastomotic leakage (EJAL) after total gastrectomy. We retrospectively analyzed the data of 81 patients with EJAL who had undergone total gastrectomy and Roux-en-Y reconstruction at Fujian Medical University Union Hospital between January 2014 and December 2021. The patients were divided into experimental (12 patients with new gastrointestinal decompression tube plus conservative treatment) and control (69 patients with conservative treatment) groups, according to the different treatment methods they received. Anatomic defect size linearly correlated with time to clinical success, hospital stay, and hospital cost in the control group. The two groups showed no significant differences in anastomotic defect size, time of defect after surgery, hospitalization cost, and time of antibiotic use. However, the time to clinical success was significantly shorter in the experimental group than in the control group (16.0 ± 8.3 vs. 23.6 ± 17.8, P = 0.04), as was the length of hospital stay (30.1 ± 6.3 vs. 36.8 ± 16.7, P = 0.017). Furthermore, when the defect size was ≥ 4 mm, the time to clinical success, hospital stay, and hospital cost in the experimental group were lower than those in the control group (P < 0.05). Placement of a new gastrointestinal decompression tube is a safe treatment. When the defect size is ≥ 4 mm, the time to clinical success, length of hospital stay, and hospital cost can be reduced.

The effects of uncut Roux-en-Y anastomosis on laparoscopic radical gastrectomy patients' postoperative complications and quality of life

OBJECTIVES

This study discusses and analyzes the effects of uncut Roux-en-Y anastomosis on the postoperative complications and quality of life of gastric cancer patients after they undergo laparoscopic total gastrectomies.

METHODS

86 patients admitted to our hospital for laparoscopic digestive tract reconstruction after distal gastrectomies were recruited as the study cohort and divided into group A (n=41) or group B (n=45) on the basis of the different digestive tract reconstruction surgery each patient underwent. The group-A patients underwent traditional Roux-en-Y anastomosis, and the group-B patients underwent uncut Roux-en-Y anastomosis. The operation outcomes, the early and late postoperative complications, the decline in the postoperative nutrition status, and the changes in the postoperative quality of life scores were compared between the two groups.

RESULTS

The intraoperative anastomosis times and the blood losses, the postoperative ventilation, the liquid food intake times, and the hospitalization durations in group B were lower than they were in group A (P<0.05). The incidences of early and late postoperative complications in group A was significantly higher than they were in group B (P<0.05). The decrease of the TP, ALB, and Hb levels in group B was dramatically lower than it was in group A at 6 months after the surgeries (P<0.05), and no significant difference in the TP, ALB, or Hb levels was observed between the two groups at 12 months after the surgeries (P>0.05). The QOL scores in the two groups of patients were increased at 6 and 12 months after the surgeries compared with 1 month after the surgeries (P<0.05). The QOL scores in group B were notably higher than they were in group A at 6 and 12 months after the surgeries (P<0.05).

CONCLUSION

Uncut Roux-en-Y anastomosis after laparoscopic total gastrectomy is simple to carry out. The method can promote patients' early postoperative recovery, reduce their early and late complications, and maintain their postoperative nutritional status, thus improving their postoperative quality of life, so it is worthy of clinical promotion.

Continuous negative pressure irrigation with double cannula through the anterior sacral space for treatment of anastomotic fistula after anus-preserving laparoscopic radical resection for ultra-low rectal cancer in elderly patients

BACKGROUND

Ultra-low rectal cancer refers to rectal cancer where the lower edge of the tumor is less than 5 cm from the dentate line. It is mostly caused by genetics, diet, chronic inflammation of the large intestine, and many other factors. Surgery is the main method of treatment for rectal cancer. Although surgery can effectively control the deterioration of the disease and remove the diseased tissue, postoperative complications such as anastomotic leakage often occur, which is not conducive to the prognosis and even threatens the life and health of patients. The prevention and treatment of anastomotic leakage in elderly patients after surgery are a clinical focus and difficulty.

AIM

To evaluate the effect of continuous negative pressure irrigation with double cannula through the anterior sacral space in the treatment of anastomotic fistula after anus-preserving laparoscopic radical resection for ultra-low rectal cancer in elderly patients (over 60 years old).

METHODS

One hundred and eighteen elderly patients with anastomotic fistula after laparoscopic radical resection for ultra-low rectal cancer from November 2018 to October 2020 were selected and classified into either a control group or an experimental group according to the order of admission. The control group (59 cases) underwent single-chamber drainageed, and the experimental group (59 cases) received continuous negative pressure irrigation with double cannula through the presacral space. The efficacy, time to recovery of various indications, postoperative function, and inflammatory factors were compared between the two groups.

RESULTS

The total effective rate in the experimental group (98.31%) was significantly higher than that of the control group (84.75%), and the time to extubation, time to recovery of normal body temperature, healing time, time to disappearance of lower abdominal pain, and hospital stay were significantly shorter than those of the control group (P < 0.05). The visual analogue assessment scale score of the experimental group was significantly lower than that of the control group after 2 wk of treatment, and the granulation growth grade and EORTC quality of life measurement scale score were significantly higher than those of the control group (P < 0.05). After 2 wk of treatment, white blood cell count, erythrocyte sedimentation rate, C-reactive protein, and procalcitonin were significantly lower, and vascular endothelial growth factor level was significantly higher in the experimental group than in the control group (P < 0.05).

CONCLUSION

Double cannula continuous negative pressure flushing through the presacral space is effective in the treatment of anastomotic fistula after anus-preserving laparoscopic radical resection for ultra-low rectal cancer in elderly patients, and it can quickly relieve clinical symptoms, promote the growth of fresh granulation, inhibit the release of inflammatory factors, and improve life quality.

A Comparison of Negative Pressure and Conventional Therapy in Infected Open Chest Wounds

Background: The role of negative pressure wound therapy (NPWT) in the management of open chest wounds is unclear. Our aim was to determine the safety and efficacy of NPWT compared with conventional therapy for open chest wounds. Methods: Ten patients with infected open chest wounds were included in a prospective trial of NPWT after surgical debridement. Their outcomes were compared with those of 11 control patients treated during the same period with surgical debridement and open chest packing only. The control group data were obtained by retrospective review of medical records. Results: The median duration of NPWT was eight days (range 2-29 days), with closure in eight patients (80%). Two patients having NPWT had unveiling of occult pleural fistulas leading to early discontinuation. The patients having NPWT had a shorter median time to closure (7 versus 18 days; p = 0.071) and shorter initial (median 6 versus 20 days; p = 0.026) and total (median 6 versus 25 days; p = 0.024) hospital length of stay. Control patients had higher rates of new-onset atrial fibrillation (46% versus 0; p = 0.035) and septic shock (64% versus 10%; p = 0.024). The chest was either closed or healing at the time of the last visit in 100% of the NPWT patients versus 73% of control patients (p = 0.28). The 1-year survival estimates were 90% for the NPWT patients and 80% for the control patients (p = 0.69). Conclusion: Negative pressure wound therapy is feasible and safe for open infected chest wounds in selected patients compared with open packing alone and may reduce hospital stay duration and major complication rates.

Aorta Calcification Increases the Risk of Anastomotic Leakage After Gastrectomy in Gastric Cancer Patients

Purpose

The purpose of the present study was to evaluate whether vascular calcification is a risk factor for anastomotic leakage after gastrectomy in gastric cancer patients.

Methods

Patients with confirmed gastric cancer were collected from the database of a single clinical center from January 2013 to January 2019. The calcification score and anastomotic leakage were recorded, and predictors of anastomotic leakage were analyzed.

Results

A total of 856 patients were included in this study; 818 patients had no anastomotic leakage, and 38 patients had anastomotic leakage. The ratio of hypertension status (p=0.011), open gastrectomy (p=0.012), postoperative length of stay (p=0.000), aorta calcification score (p=0.000) and celiac axis calcification (p=0.000) were higher in the anastomotic leakage group than in the nonanastomotic leakage group. In multivariate analysis, aorta calcification (p=0.029, odds ratio =2.425, 95% CI=1.095–5.491) was an independent predictor of the anastomotic leakage.

Conclusion

Aorta calcification is an independent risk factor for anastomotic leakage after gastrectomy in gastric cancer patients.