Application of double layered end-to-end anastomosis with continuous manual suture for completing digestive tract reconstruction in totally laparoscopic distal gastrectomy

Abstract Background We retrospectively reviewed and consecutively collected the clinical data of distal gastric cancer patients who received surgical treatment, and we discuss the safety and feasibility of double layered end-to-end anastomosis with continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy. Methods We reviewed the clinical data of 41 patients with distal gastric cancer from the gastroenterology department of the Second Affiliated Hospital of Dalian Medical University, from September 2018 to August 2019, who underwent totally laparoscopic distal gastrectomy. During the operation, the method of double layered end-to-end anastomosis with continuous manual suture was used for Billroth type I anastomosis to complete digestive tract reconstruction. All patients have been given a follow-up visit and gastroscopy three months after the operation. The peri-operative clinical information and postoperative follow-up information were collected for analysis, and the clinical application value was evaluated. Results General information: male(n = 27), female(n = 14), age = 65.02(SD 9.94) years, and BMI = 23.52(SD 2.56) kg/m2, Tumor location: antrum(32,78.0%), angle (6,14.6%), and body (3,7.3%). Clinical stage: I (27, 65.9%), II (7, 17.1%), and III (7, 17.1%). Operative information: operation time = 154.51(SD 33.37) min, anastomosis time = 26.88(SD 5.11) min; intraoperative bleeding = 66.34(SD 48.81) ml; first postoperative ambulation Median = 1(IQR 0) d, first postoperative flatus Median = 3(IQR 2) d, first postoperative diet Median = 3(IQR 1) d, postoperative hospital stay Median = 7(IQR 2) d, and total hospitalization cost = 10,935.00(SD 2205.72)USD. Differentiation degree: high and high-moderate (3,7.32%), moderate and poor-moderate (24, 58.54%), poor differentiation (14, 34.15%), dissected lymph nodes Median = 31(IQR 17), and positive lymph nodes Median = 0(IQR 1). Pathological stage: IA (20, 48.78%), IB (3, 7.32%), IIA (4, 9.76%), IIB (5, 12.20%), IIIA (1, 2.44%), IIIB (3, 7.32%), and IIIC (5, 12.20%). Complications (n = 4): lung infection (1, 2.44%), anastomotic leakage (1, 2.44%), and gastroparesis (2, 4.88%). Conclusion It is safe and feasible in clinical treatment to apply the method of double layered end-to-end anastomosis with continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy.

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Application of double needle-double layer continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy

10.21203/rs.3.rs-24971/v1 ◽

2020 ◽

Author(s):

Xinsheng Zhang ◽

weibin zhang ◽

menglang yuan ◽

xiaomeng shi ◽

HONGYI CHEN ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Digestive Tract ◽

Double Layer ◽

Distal Gastrectomy ◽

Laparoscopic Distal Gastrectomy ◽

Totally Laparoscopic Distal Gastrectomy ◽

Distal Gastric Cancer ◽

Manual Suture ◽

Totally Laparoscopic

Abstract Background Retrospectively register the clinical data of distal gastric cancer patients who received surgical treatment, discuss the safety and feasibility of double needle-double layer continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy. Methods Review the clinical data of 41 patients with distal gastric cancer from the gastroenterology department of the Second Affiliated Hospital of Dalian Medical University, from September 2018 to August 2019, were accepted the totally laparoscopic distal gastrectomy. During the operation, the method of double needle-double layer continuous manual suture was used for Billroth I type anastomosis to complete digestive tract reconstruction. The peri-operative clinical information and postoperative follow-up information were collected for analysis, and the clinical application value was evaluated. Results General Information: Male (n = 27),Female(n = 14)༌Age(65.02 ± 9.94)years, BMI(23.52 ± 2.56)kg/m2; Tumor location: Antrum(32,78.0%), Angle (6,14.6%), Body (3,7.3%); Clinical stage: I (27,65.9%), II (7,17.1%), III (7,17.1%); Operative information: Operation time (154.51 ± 33.37)min, Anastomosis time (26.88 ± 5.11) min; Intraoperative bleeding (66.34 ± 48.81) ml; First postoperative ambulation (1.07 ± 0.26) d, First postoperative flatus(3.07 ± 1.08)d, First postoperative diet(3.41 ± 1.07)d༌Postoperative hospital stay(8.76 ± 6.64)d, Total hospitalization cost (70804.00 ± 14282.05)RMB yuan; Differentiation degree: High and high-moderate(3,7.32%), Moderate and poor-moderate (24,58.54%)༌Poor differentiation (14,34.15%); Dissected lymph node (32.76 ± 13.16), Positive lymph node (2.39 ± 4.06); Pathological stage: IA (20,48.78%), IB (3,7.32%), IIA (4,9.76%), IIB (5,12.20%), IIIA (1,2.44%), IIIB (3,7.32%), IIIC (5,12.20%); Complications(n = 4): Lung infection(1,2.44%)༌Anastomotic leakage (1,2.44%༉༌Gastroparesis (2,4.88%༉; Conclusion It is safe and feasible in clinical treatment to apply the method of double needle-double layer continuous manual suture to complete digestive tract reconstruction in totally laparoscopic distal gastrectomy.

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Is totally laparoscopic gastrectomy without prophylactic drains feasible for patients with distal gastric cancer? The experience of China National Cancer Center

10.21203/rs.3.rs-21343/v1 ◽

2020 ◽

Author(s):

hao liu ◽

Peng Jin ◽

Quan Xu ◽

Yibin Xie ◽

Fuhai Ma ◽

...

Keyword(s):

Gastric Cancer ◽

Distal Gastrectomy ◽

Operating Time ◽

Laparoscopic Distal Gastrectomy ◽

Cancer Center ◽

Prophylactic Drainage ◽

Totally Laparoscopic Distal Gastrectomy ◽

Distal Gastric Cancer ◽

Drain Group ◽

Totally Laparoscopic

Abstract Background Prophylactic drains have been used to remove intraperitoneal collections and to detect complications early in open surgery. In the last decades, Gastric cancer minimally invasive surgery has been widely carried out throughout the world. However, little has been reported on routine prophylactic abdominal drainage after totally laparoscopic distal gastrectomy. To evaluate the feasibility of without prophylactic drains in totally laparoscopic distal gastrectomy in selective patients. Methods Data of distal gastric cancer patients underwent totally laparoscopic distal gastrectomy with and without prophylactic drainage at China National Cancer Center/Cancer Hospital from February 2018 to August 2019 were reviewed. The outcomes of patients with and without a prophylactic drainage were compared. Results A total of 420 patients who underwent surgery for gastric cancer were identified; of these, 88 patients who received totally lapaoscopic distal gastrectomy were included. The incidence of concurrent illness was higher in the drain group, (48.8% vs. 27.7%, p = 0.041). The overall postoperative complication rate was 19.5% in the drain group (n = 47), and 10.6% in the no-drain group (n = 41), there were no significant differences between two groups (p > 0.05). The need for percutaneous catheter drainage (PCD) was also not significantly different between groups (9.8% vs. 6.4%, p = 0.700). However, patients with larger BMI (≥ 29) are prone to postoperative complications (p = 0.042). In addition, more operating time cost in the drain group than in the no-drain group (188.10 ± 38.89 min vs. 164.30 ± 36.97 min, p < 0.05). The number of days after surgery until the initiation of soft diet (5.34 ± 2.27 days vs. 4.17 ± 2.13 days, p < 0.05) and first flatus (4.29 ± 1.45 days vs. 3.55 ± 1.83 days, p = 0.041) were greater in the drain group. Conclusions Without prophylactic drainage may reduce surgery time and result in faster recovery. Routine prophylactic drains are not necessary in selective patients. A prophylactic drain may be useful in patients at higher risk.

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