A 64-year-old man was admitted to our hospital with hematemesis and melena.Six years ago,he had undergone total gastrectomy with Roux-en-Y esophagojejunostomy for gastric cancer.Endoscopic examination revealed varicos...A 64-year-old man was admitted to our hospital with hematemesis and melena.Six years ago,he had undergone total gastrectomy with Roux-en-Y esophagojejunostomy for gastric cancer.Endoscopic examination revealed varicose veins at the anastomotic sites with cherry-red spots and hemorrhage.Abdominal computed tomography showed that the varices were supplied by a dilated jejunal vein.Transjugular intrahepatic portosystemic shunt(TIPS)and variceal embolization were performed.There were no major complications or episodes of bleeding during the three-month follow-up.We conclude that TIPS in combination with varices obliteration is an effective alternative method for treatment of ruptured esophagojejunal varices after total gastrectomy.展开更多
BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a serious and potentially crucial complication of total gastrectomy and represents the major cause of postoperative death,with a mortality rate of up to 50%.Howev...BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a serious and potentially crucial complication of total gastrectomy and represents the major cause of postoperative death,with a mortality rate of up to 50%.However,treatment remains challenging and controversial.We report here the case of a patient whose intrathoracic EJAL was successfully treated with computer tomography(CT)-guided negative pressure drainage treatment.CASE SUMMARY A 69-year-old male patient complained of difficulty swallowing within the last six months.He was diagnosed with esophagogastric junction carcinoma,Siewert II,cT3N0M0 stage II.Total gastrectomy and Roux-en-Y esophagojejunostomy were performed.High fever,left chest pain and dyspnea appeared on postoperative day 5,and EJAL was confirmed by CT,gastroscopy and oral blue-dimethylene tests.Conservative treatment measures were applied immediately,including antibiotics,nasojejunal tubes,and repeated thoracic puncture and drainage under ultrasound guidance.However,without sufficient and effective drainage,the thoracic infection and systemic condition continued to deteriorate.With the cooperation of multiple departments,percutaneous CT-guided drainage(24 Fr 7 mm)in the thoracic cavity was successfully placed near the anastomotic leakage.Because of continuous negative pressure suction,the infection symptoms were effectively controlled and the general situation gradually recovered.Subsequent follow-up examination showed that the patient was in good condition.CONCLUSION Negative pressure drainage via CT may represent an effective minimally invasive approach to treating intrathoracic EJAL.展开更多
BACKGROUND Magnetic compression anastomosis(MCA)is a simple procedure contributing to a reliable anastomosis.However,digestive-tract reconstruction after total gastrectomy using MCA has not yet been reported.AIM To in...BACKGROUND Magnetic compression anastomosis(MCA)is a simple procedure contributing to a reliable anastomosis.However,digestive-tract reconstruction after total gastrectomy using MCA has not yet been reported.AIM To investigate the feasibility of MCA for simultaneous esophagojejunostomy and jejunojejunostomy after total gastrectomy using beagle dogs.METHODS Sixteen beagles were randomly divided into an MCA group(study group,n=8)and a manual-suture anastomosis group(control group,n=8).Two different magnetic anastomosis devices were used in the study group for esophagojejunal and jejunojejunal anastomoses.Both devices included a pair of circular daughter and parent magnets each.The time of esophagojejunostomy and jejunojejunostomy,postoperative complications,and survival rate of the two groups were compared.The dogs were sacrificed one month after the operation and their anastomotic specimens were obtained.Healing was observed by the naked eye and a light microscope.RESULTS Digestive-tract reconstruction after total gastrectomy was successfully completed in both groups(survival rate=100%).In the study group,esophagojejunal and jejunojejunal anastomoses took 6.13±0.58 and 4.06±0.42 min,respectively,significantly lower than those in the control group(15.63±1.53 min,P<0.001 and 10.31±1.07 min,P<0.001,respectively).Complications such as bleeding,anastomotic leakage,and anastomotic stenosis were not observed.In the study group,the magnets did not interfere with each other.Discharge time of the jejunojejunal magnetic anastomosis device was 10.75±1.28 d,while that of the esophagojejunal magnetic anastomosis device was 12.25±1.49 d.Residual silk was found in the control group.The study group showed a greater smoothness of the anastomosis than that of the control group.All layers of anastomosis healed well in both groups.CONCLUSION MCA is a safe and feasible procedure for digestive-tract reconstruction after total gastrectomy in this animal model.展开更多
AIM:To evaluate the feasibility and safety of full robotassisted gastrectomy with intracorporeal robot handsewn anastomosis in the treatment of gastric cancer.METHODS:From September 2011 to March 2013,110consecutive p...AIM:To evaluate the feasibility and safety of full robotassisted gastrectomy with intracorporeal robot handsewn anastomosis in the treatment of gastric cancer.METHODS:From September 2011 to March 2013,110consecutive patients with gastric cancer at the authors’institution were enrolled for robotic gastrectomies.According to tumor location,total gastrectomy,distal or proximal subtotal gastrectomy with D2 lymphadenectomy was fully performed by the da Vinci Robotic Surgical System.All construction,including Roux-en-Y jejunal limb,esophagojejunal,gastroduodenal and gastrojejunal anastomoses were fully carried out by the intracorporeal robot-sewn method.At the end of surgery,the specimen was removed through a 3-4 cm incision at the umbilicus trocar point.The details of the surgical technique are well illustrated.The benefits in terms of surgical and oncologic outcomes are well documented,as well as the failure rate and postoperative complications.RESULTS:From a total of 110 enrolled patients,radical gastrectomy could not be performed in 2 patients due to late stage disease;1 patient was converted to laparotomy because of uncontrollable hemorrhage,and1 obese patient was converted due to difficult exposure;2 patients underwent extra-corporeal anastomosis by minilaparotomy to ensure adequate tumor margin.Robot-sewn anastomoses were successfully performed for 12 proximal,38 distal and 54 total gastrectomies.The average surgical time was 272.52±53.91 min and the average amount of bleeding was 80.78±32.37 mL.The average number of harvested lymph nodes was 23.1±5.3.All specimens showed adequate surgical margin.With regard to tumor staging,26,32 and 46 patients were staged asⅠ,ⅡandⅢ,respectively.The average hospitalization time after surgery was 6.2 d.One patient experienced a duodenal stump anastomotic leak,which was mild and treated conservatively.One patient was readmitted for intra-abdominal infection and was treated conservatively.Jejunal afferent loop obstruction occurred in 1 patient,who underwent re-operation and recovered quickly.CONCLUSION:This technique is feasible and can produce satisfying postoperative outcomes.It is also convenience and reliable for anastomoses in gastrectomy.Full robotic hand-sewn anastomosis may be a minimally invasive technique for gastrectomy surgery.展开更多
To show outcomes of our series of patients that underwent a total gastrectomy with a robotic approach and highlight the technical details of a proposed solution for the reconstruction phase.METHODSData of gastrectomie...To show outcomes of our series of patients that underwent a total gastrectomy with a robotic approach and highlight the technical details of a proposed solution for the reconstruction phase.METHODSData of gastrectomies performed from May 2014 to October 2016, were extracted and analyzed. Basic characteristics of patients, surgical and clinical outcomes were reported. The technique for reconstruction (Parisi Technique) consists on a loop of bowel shifted up antecolic to directly perform the esophago-enteric anastomosis followed by a second loop, measured up to 40 cm starting from the esojejunostomy, fixed to the biliary limb to create an enteroenteric anastomosis. The continuity between the two anastomoses is interrupted just firing a linear stapler, so obtaining the Roux-en-Y by avoiding to interrupt the mesentery.RESULTSFifty-five patients were considered in the present analysis. Estimated blood loss was 126.55 ± 73 mL, no conversions to open surgery occurred, R0 resections were obtained in all cases. Hospital stay was 5 (3-17) d, no anastomotic leakage occurred. Overall, a fast functional recovery was shown with a median of 3 (3-6) d in starting a solid diet.CONCLUSIONRobotic surgery and the adoption of a tailored reconstruction technique have increased the feasibility and safety of a minimally invasive approach for total gastrectomy. The present series of patients shows its implementation in a western center with satisfying short-term outcomes.展开更多
BACKGROUND Gastrografin swallow,methylthioninium chloride test,and computed tomography(CT)are the main methods for postoperative anastomotic fistula detection.Correct selection and application of examinations and ther...BACKGROUND Gastrografin swallow,methylthioninium chloride test,and computed tomography(CT)are the main methods for postoperative anastomotic fistula detection.Correct selection and application of examinations and therapies are significant for the early diagnosis and treatment of small anastomotic fistulas after radical gastrectomy,which are conducive to postoperative recovery.CASE SUMMARY A 44-year-old woman underwent radical total gastrectomy for laparoscopic gastric cancer.The patient developed a fever after surgery.The methylthioninium chloride test and early CT suggested no anastomotic fistula,but gastrografin swallow and late CT showed the opposite result.The fistula was successfully closed using an endoscopic clip.The methylthioninium chloride test,gastrografin,and CT performed on different postoperative dates for small esophagojejunostomy fistulas are different.The size of the anastomotic fistula is an important factor for the success of endoscopic treatment.CONCLUSION The advantages and limitations of the diagnosis of different examinations of small esophagojejunostomy fistulas are noteworthy.The size of the leakage of the anastomosis is an important basis for selecting the repair method.展开更多
文摘A 64-year-old man was admitted to our hospital with hematemesis and melena.Six years ago,he had undergone total gastrectomy with Roux-en-Y esophagojejunostomy for gastric cancer.Endoscopic examination revealed varicose veins at the anastomotic sites with cherry-red spots and hemorrhage.Abdominal computed tomography showed that the varices were supplied by a dilated jejunal vein.Transjugular intrahepatic portosystemic shunt(TIPS)and variceal embolization were performed.There were no major complications or episodes of bleeding during the three-month follow-up.We conclude that TIPS in combination with varices obliteration is an effective alternative method for treatment of ruptured esophagojejunal varices after total gastrectomy.
基金Supported by National Natural Science Foundation of China,No.H0306/81100254.
文摘BACKGROUND Esophagojejunal anastomotic leakage(EJAL)is a serious and potentially crucial complication of total gastrectomy and represents the major cause of postoperative death,with a mortality rate of up to 50%.However,treatment remains challenging and controversial.We report here the case of a patient whose intrathoracic EJAL was successfully treated with computer tomography(CT)-guided negative pressure drainage treatment.CASE SUMMARY A 69-year-old male patient complained of difficulty swallowing within the last six months.He was diagnosed with esophagogastric junction carcinoma,Siewert II,cT3N0M0 stage II.Total gastrectomy and Roux-en-Y esophagojejunostomy were performed.High fever,left chest pain and dyspnea appeared on postoperative day 5,and EJAL was confirmed by CT,gastroscopy and oral blue-dimethylene tests.Conservative treatment measures were applied immediately,including antibiotics,nasojejunal tubes,and repeated thoracic puncture and drainage under ultrasound guidance.However,without sufficient and effective drainage,the thoracic infection and systemic condition continued to deteriorate.With the cooperation of multiple departments,percutaneous CT-guided drainage(24 Fr 7 mm)in the thoracic cavity was successfully placed near the anastomotic leakage.Because of continuous negative pressure suction,the infection symptoms were effectively controlled and the general situation gradually recovered.Subsequent follow-up examination showed that the patient was in good condition.CONCLUSION Negative pressure drainage via CT may represent an effective minimally invasive approach to treating intrathoracic EJAL.
基金the Institutional Foundation of The First Affiliated Hospital of Xi’an Jiaotong University,No.2022MS-07(to Yan XP)Key Research and Development Plan of Shaanxi Province,No.2021GXLH-Z-009(to Li Y).
文摘BACKGROUND Magnetic compression anastomosis(MCA)is a simple procedure contributing to a reliable anastomosis.However,digestive-tract reconstruction after total gastrectomy using MCA has not yet been reported.AIM To investigate the feasibility of MCA for simultaneous esophagojejunostomy and jejunojejunostomy after total gastrectomy using beagle dogs.METHODS Sixteen beagles were randomly divided into an MCA group(study group,n=8)and a manual-suture anastomosis group(control group,n=8).Two different magnetic anastomosis devices were used in the study group for esophagojejunal and jejunojejunal anastomoses.Both devices included a pair of circular daughter and parent magnets each.The time of esophagojejunostomy and jejunojejunostomy,postoperative complications,and survival rate of the two groups were compared.The dogs were sacrificed one month after the operation and their anastomotic specimens were obtained.Healing was observed by the naked eye and a light microscope.RESULTS Digestive-tract reconstruction after total gastrectomy was successfully completed in both groups(survival rate=100%).In the study group,esophagojejunal and jejunojejunal anastomoses took 6.13±0.58 and 4.06±0.42 min,respectively,significantly lower than those in the control group(15.63±1.53 min,P<0.001 and 10.31±1.07 min,P<0.001,respectively).Complications such as bleeding,anastomotic leakage,and anastomotic stenosis were not observed.In the study group,the magnets did not interfere with each other.Discharge time of the jejunojejunal magnetic anastomosis device was 10.75±1.28 d,while that of the esophagojejunal magnetic anastomosis device was 12.25±1.49 d.Residual silk was found in the control group.The study group showed a greater smoothness of the anastomosis than that of the control group.All layers of anastomosis healed well in both groups.CONCLUSION MCA is a safe and feasible procedure for digestive-tract reconstruction after total gastrectomy in this animal model.
基金Supported by Partially funded by a sponsorship from the Social Development Fund of Jiangsu Province,No.BS2007054
文摘AIM:To evaluate the feasibility and safety of full robotassisted gastrectomy with intracorporeal robot handsewn anastomosis in the treatment of gastric cancer.METHODS:From September 2011 to March 2013,110consecutive patients with gastric cancer at the authors’institution were enrolled for robotic gastrectomies.According to tumor location,total gastrectomy,distal or proximal subtotal gastrectomy with D2 lymphadenectomy was fully performed by the da Vinci Robotic Surgical System.All construction,including Roux-en-Y jejunal limb,esophagojejunal,gastroduodenal and gastrojejunal anastomoses were fully carried out by the intracorporeal robot-sewn method.At the end of surgery,the specimen was removed through a 3-4 cm incision at the umbilicus trocar point.The details of the surgical technique are well illustrated.The benefits in terms of surgical and oncologic outcomes are well documented,as well as the failure rate and postoperative complications.RESULTS:From a total of 110 enrolled patients,radical gastrectomy could not be performed in 2 patients due to late stage disease;1 patient was converted to laparotomy because of uncontrollable hemorrhage,and1 obese patient was converted due to difficult exposure;2 patients underwent extra-corporeal anastomosis by minilaparotomy to ensure adequate tumor margin.Robot-sewn anastomoses were successfully performed for 12 proximal,38 distal and 54 total gastrectomies.The average surgical time was 272.52±53.91 min and the average amount of bleeding was 80.78±32.37 mL.The average number of harvested lymph nodes was 23.1±5.3.All specimens showed adequate surgical margin.With regard to tumor staging,26,32 and 46 patients were staged asⅠ,ⅡandⅢ,respectively.The average hospitalization time after surgery was 6.2 d.One patient experienced a duodenal stump anastomotic leak,which was mild and treated conservatively.One patient was readmitted for intra-abdominal infection and was treated conservatively.Jejunal afferent loop obstruction occurred in 1 patient,who underwent re-operation and recovered quickly.CONCLUSION:This technique is feasible and can produce satisfying postoperative outcomes.It is also convenience and reliable for anastomoses in gastrectomy.Full robotic hand-sewn anastomosis may be a minimally invasive technique for gastrectomy surgery.
文摘To show outcomes of our series of patients that underwent a total gastrectomy with a robotic approach and highlight the technical details of a proposed solution for the reconstruction phase.METHODSData of gastrectomies performed from May 2014 to October 2016, were extracted and analyzed. Basic characteristics of patients, surgical and clinical outcomes were reported. The technique for reconstruction (Parisi Technique) consists on a loop of bowel shifted up antecolic to directly perform the esophago-enteric anastomosis followed by a second loop, measured up to 40 cm starting from the esojejunostomy, fixed to the biliary limb to create an enteroenteric anastomosis. The continuity between the two anastomoses is interrupted just firing a linear stapler, so obtaining the Roux-en-Y by avoiding to interrupt the mesentery.RESULTSFifty-five patients were considered in the present analysis. Estimated blood loss was 126.55 ± 73 mL, no conversions to open surgery occurred, R0 resections were obtained in all cases. Hospital stay was 5 (3-17) d, no anastomotic leakage occurred. Overall, a fast functional recovery was shown with a median of 3 (3-6) d in starting a solid diet.CONCLUSIONRobotic surgery and the adoption of a tailored reconstruction technique have increased the feasibility and safety of a minimally invasive approach for total gastrectomy. The present series of patients shows its implementation in a western center with satisfying short-term outcomes.
文摘BACKGROUND Gastrografin swallow,methylthioninium chloride test,and computed tomography(CT)are the main methods for postoperative anastomotic fistula detection.Correct selection and application of examinations and therapies are significant for the early diagnosis and treatment of small anastomotic fistulas after radical gastrectomy,which are conducive to postoperative recovery.CASE SUMMARY A 44-year-old woman underwent radical total gastrectomy for laparoscopic gastric cancer.The patient developed a fever after surgery.The methylthioninium chloride test and early CT suggested no anastomotic fistula,but gastrografin swallow and late CT showed the opposite result.The fistula was successfully closed using an endoscopic clip.The methylthioninium chloride test,gastrografin,and CT performed on different postoperative dates for small esophagojejunostomy fistulas are different.The size of the anastomotic fistula is an important factor for the success of endoscopic treatment.CONCLUSION The advantages and limitations of the diagnosis of different examinations of small esophagojejunostomy fistulas are noteworthy.The size of the leakage of the anastomosis is an important basis for selecting the repair method.
