Impact of double-flap technique for reconstruction after proximal gastrectomy.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 134-134
Author(s):  
Kazuki Asanuma ◽  
Hirofumi Kawakubo ◽  
Shuhei Mayanagi ◽  
Rieko Nakamura ◽  
Tomoyuki Irino ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Gastroesophageal Reflux ◽  
Hospital Stay ◽  
Proximal Gastrectomy ◽  
Operation Time ◽  
Postoperative Hospital Stay ◽  
Endoscopic Findings ◽  
Flap Technique ◽  
Postoperative Reflux ◽  
One Year

134 Background: Proximal gastrectomy (PG) has been performed for proximal early gastric cancer as a minimally invasive procedure. In PG, gastroesophageal reflux disease (GERD) becomes problem, thus several techniques have been reported to reduce GERD. So far, we have mainly performed the method of anastomosis based on double stapling technique (DST) using a trans-oral anvil delivery system for reconstruction after PG. For preventing GERD, we recently introduced double-flap technique (DFT) reported to be more physiological anti-reflux reconstruction which can prevent GERD. So, this study shows superiority of DFT compared to DST. Methods: Patients who have undergone PG for proximal gastric cancer during Jan. 2012 to Jul. 2017 in our hospital were reviewed as candidates. Operation time, blood loss, postoperative anastomotic complication, postoperative hospital stay, postoperative reflux symptom or endoscopic findings, intake of proton pump inhibitor (PPI) at 1 year after the operation, and postoperative nutritional status were retrospectively investigated. Results: DFT was performed in 26 patients whereas DST was performed in 38 patients. Average operation time and postoperative hospital stay was not significant in both groups (DFT group; 275.8±41.4 minutes, 13.6±8.9 days, DST group; 252.2±82.9 minutes, 15.2±7.2 days, respectively). As for postoperative complications higher than Clavien-Dindo Grade III, one case of suture failure was observed in DFT group. Postoperative reflux symptoms and endoscopic findings of gastroesophageal reflux were significantly frequent in DST group compared to DFT group (Reflux symptoms, DFT group : DST group = 0 : 7(p = 0.03), Endoscopic findings, DFT group : DST group = 1 : 11(p < 0.01) , respectively). There were significantly more cases of PPI taking one year after the operation in DST group(DFT group : DST group = 8 : 28 (p < 0.01) ). Average weight loss at one year after the operation and serum level of albumin of in DFT group were 6.0±4.7kg and 4.11±0.29 g/dL, respectively and DST group were 7.6±5.3kg and 3.95±0.39 g/dL, respectively and there were no significance between two groups. Conclusions: DFT is superior to DST as a reconstruction method after PG in terms of suppressing GERD.

scholarly journals Laparoscopic proximal gastrectomy with double-tract reconstruction for upper third gastric cancer

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shuo-meng Xiao ◽  
Ping Zhao ◽  
Zhi Ding ◽  
Rui Xu ◽  
Chao Yang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Proximal Gastrectomy ◽  
Operation Time ◽  
Nutrition Status ◽  
Proximal Gastric Cancer ◽  
Double Tract Reconstruction ◽  
Significant Difference ◽  
Laparoscopic Proximal Gastrectomy ◽  
Gastric Cancer Patients ◽  
Upper Third

Abstract Background Proximal gastrectomy with double-tract reconstruction (DTR) has been used for upper third gastric cancer as a function-preserving procedure. However, the safety and feasibility of laparoscopic proximal gastrectomy (LPG) with DTR remain uncertain. This study compared open proximal gastrectomy (OPG) with DTR and LPG with DTR for proximal gastric cancer. Methods Sixty-four patients who had undergone OPG with DTR and forty-six patients who had undergone LPG with DTR were enrolled in this case–control study. The clinical characteristics, surgical outcomes and postoperative nutrition index were analysed retrospectively. Results The operation time was significantly longer in the LGP group than in the OPG group (258.3 min vs 205.8 min; p = 0.00). However, the time to first flatus and postoperative hospital stay were shorter in the LPG group [4.0 days vs 3.5 days (p = 0.00) and 10.6 days vs 9.2 days (p = 0.001), respectively]. No significant difference was found between the two groups in the number of retrieved lymph nodes, complications or reflux oesophagitis. The nutrition status was assessed using the haemoglobin, albumin, prealbumin and weight levels from pre-operation to six months after surgery. No significant difference was found between the groups. Conclusion LPG with DTR can be safely performed for proximal gastric cancer patients by experienced surgeons.

scholarly journals Infective complications after percutaneous nephrolithotomy in relation to preoperative urine culture status

2019 ◽  
Vol 6 (1) ◽  
pp. 8-13
Author(s):  
Birendra Kumar Yadav ◽  
Robin Bahadur Basnet ◽  
Anil Shrestha ◽  
Parish Mani Shrestha
Keyword(s):  
Hospital Stay ◽  
Percutaneous Nephrolithotomy ◽  
Urine Culture ◽  
Operation Time ◽  
Group A ◽  
One Year ◽  
Group B ◽  
Stone Characteristics ◽  
Negative Urine Culture ◽  
Infective Complications

Introductions: Fever and sepsis after percutaneous nephrolithotomy (PCNL) secondary to urinary tract infection is a major determinant of overall post PCNL complications. This study aims to analyse infective complications after PCNL in relation to pre-operative urine culture status. Methods: A comparative analysis of post PCNL infective complications in pre-operative urine culture positive (Group A) and negative (Group B) was done for one year during June 2017 to May 2018 in department of urology, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal. Demographics, stone characteristics, mean operative time, post-operative hospital stay and post-operative complications as per Modified Clavien classification were compared between the two groups. Results: Out of total 136 PCNL patients, 51 were in Group A and 85 in Group B. Infective complications were significantly high, 28 (54.90%) in group A compared to 20 (23.53%) in group B, p=0.004. The most common isolate was Escherichia coli 19 (37.25%), sensitive to amikacin 37 (72.55%). The mean operation time, transfusion and hospital stay was not statically different in two groups. Morality occurred in 1 (1.96%) in group A. Conclusions: Infective complications were significantly high after PCNL in patients with preoperative positive urine culture, even when it was treated to sterile with sensitive antibiotics, compared to patients with preoperative negative urine culture.

scholarly journals Intelligent Algorithm-Based Magnetic Resonance Imaging in Radical Gastrectomy under Laparoscope

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Wenkui Mo ◽  
Cansong Zhao
Keyword(s):  
Gastric Cancer ◽  
Operation Time ◽  
Laparoscopic Group ◽  
Postoperative Hospital Stay ◽  
Intraoperative Blood Loss ◽  
Resonance Imaging ◽  
Intelligent Algorithm ◽  
Short Term ◽  
Laparoscopy Group ◽  
Significant Difference

The study focused on the influence of intelligent algorithm-based magnetic resonance imaging (MRI) on short-term curative effects of laparoscopic radical gastrectomy for gastric cancer. A convolutional neural network- (CNN-) based algorithm was used to segment MRI images of patients with gastric cancer, and 158 subjects admitted at hospital were selected as research subjects and randomly divided into the 3D laparoscopy group and 2D laparoscopy group, with 79 cases in each group. The two groups were compared for operation time, intraoperative blood loss, number of dissected lymph nodes, exhaust time, time to get out of bed, postoperative hospital stay, and postoperative complications. The results showed that the CNN-based algorithm had high accuracy with clear contours. The similarity coefficient (DSC) was 0.89, the sensitivity was 0.93, and the average time to process an image was 1.1 min. The 3D laparoscopic group had shorter operation time (86.3 ± 21.0 min vs. 98 ± 23.3 min) and less intraoperative blood loss (200 ± 27.6 mL vs. 209 ± 29.8 mL) than the 2D laparoscopic group, and the difference was statistically significant ( P < 0.05 ). The number of dissected lymph nodes was 38.4 ± 8.5 in the 3D group and 36.1 ± 6.0 in the 2D group, showing no statistically significant difference ( P > 0.05 ). At the same time, no statistically significant difference was noted in postoperative exhaust time, time to get out of bed, postoperative hospital stay, and the incidence of complications ( P > 0.05 ). It was concluded that the algorithm in this study can accurately segment the target area, providing a basis for the preoperative examination of gastric cancer, and that 3D laparoscopic surgery can shorten the operation time and reduce intraoperative bleeding, while achieving similar short-term curative effects to 2D laparoscopy.

scholarly journals The Benefits of a Double-Flap Technique after Proximal Gastrectomy in Upper-Third Gastric Cancer

2019 ◽  
Vol 52 (9) ◽  
pp. 494-503
Author(s):  
Yuya Tanaka ◽  
Taro Isobe ◽  
Fumihiko Fujita ◽  
Tomoya Sudo ◽  
Hideaki Kaku ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Proximal Gastrectomy ◽  
Flap Technique ◽  
Upper Third

scholarly journals Short-term and long-term comparisons of laparoscopy-assisted proximal gastrectomy with esophagogastrostomy by the double-flap technique and laparoscopy-assisted total gastrectomy for proximal gastric cancer

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242223
Author(s):  
Tomoko Tsumura ◽  
Shinji Kuroda ◽  
Masahiko Nishizaki ◽  
Satoru Kikuchi ◽  
Yoshihiko Kakiuchi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Nutritional Status ◽  
Total Gastrectomy ◽  
Proximal Gastrectomy ◽  
Proximal Gastric Cancer ◽  
Short Term ◽  
Flap Technique ◽  
Significant Difference

Background Although proximal gastrectomy (PG) is a recognized surgical procedure for early proximal gastric cancer, total gastrectomy (TG) is sometimes selected due to concern about severe gastroesophageal reflux. Esophagogastrostomy by the double-flap technique (DFT) is an anti-reflux reconstruction after PG, and its short-term effectiveness has been reported. However, little is known about the long-term effects on nutritional status and quality of life (QOL). Methods Gastric cancer patients who underwent laparoscopy-assisted PG (LAPG) with DFT or laparoscopy-assisted TG (LATG) between April 2011 and March 2014 were retrospectively analyzed. Body weight (BW), body mass index (BMI), and prognostic nutritional index (PNI) were reviewed to assess nutritional status, and the Postgastrectomy Syndrome Assessment Scale (PGSAS)-45 was used to assess QOL. Results A total of 36 patients (LATG: 17, LAPG: 19) were enrolled. Four of 17 LATG patients (24%) were diagnosed with Stage ≥II after surgery, and half received S-1 adjuvant chemotherapy. BW and PNI were better maintained in LAPG than in LATG patients until 1-year follow-up. Seven of 16 LATG patients (44%) were categorized as “underweight (BMI<18.5 kg/m2)” at 1-year follow-up, compared to three of 18 LAPG patients (17%; p = 0.0836). The PGSAS-45 showed no significant difference in all QOL categories except for decreased BW (p = 0.0132). Multivariate analysis showed that LATG was the only potential risk factor for severe BW loss (odds ratio: 3.03, p = 0.0722). Conclusions LAPG with DFT was superior to LATG in postoperative nutritional maintenance, and can be the first option for early proximal gastric cancer.

scholarly journals Comparison of Perioperative Outcomes in Open and Laparoscopic Radical Cystectomy with Modified Ureterosigmoidostomy (MainzII): A Retrospective Analysis

2021 ◽  
Author(s):  
Bin Zhang ◽  
Yang He ◽  
Duo Zheng ◽  
Junyao Liu ◽  
Peng Qi ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Radical Cystectomy ◽  
Urinary Diversion ◽  
Open Surgery ◽  
Operation Time ◽  
Laparoscopic Group ◽  
Postoperative Hospital Stay ◽  
Intraoperative Blood Loss

Abstract Background: To analyze perioperative conditions and long-term efficacy of open modified ureterosigmoidostomy urinary diversion (OMUUD) in patients with bladder cancer who underwent open radical cystectomy (ORC) and laparoscopic radical cystectomy (LRC).Methods: In this retrospective study, the clinical data of patients who underwent open and laparoscopic radical cystectomy plus open modified ureterosigmoidostomy urinary diversion in our hospital were collected from January 2011 to December 2019. In addition, perioperative data of 56 patients who underwent ORC and OMUUD were compared with those of 118 patients who underwent laparoscopic radical cystectomy (LRC) plus OMUUD. A long-term follow-up was performed to compare the overall survival (OS) and progression-free survival (PFS) rate between the two groups.Results: Results showed that there was no significant difference between ORC+OMUUD group and LRC+OMUUD group in terms of gender, age, body index, pre-operative ASA grade, history of transurethral resection of bladder tumor (TURBT) before surgery, tumor T stage, lymph node dissection range, pathological grade, and positive postoperative surgical margin. The mean operation time in the open group was shorter than that in the laparoscopic group （P<0.001）. Moreover, the estimated intraoperative blood loss（P<0.001）and postoperative hospital stay（P=0.023）were better in the laparoscopic group than in the open group. The incidence of complications between 30 days (P=0.665) and 90 days (P=0.211) time-points after surgery was not significantly different. Similarly, the OS (P=0.237) and PFS (P=0.307) between the two groups were comparable.Conclusion: This study shows that the LRC group has long operation time, but less estimated intraoperative blood loss, short postoperative hospital stay, small trauma, and fast postoperative recovery compared to open surgery. Moreover, the incidence of complications at 30 - and 90-days postoperation, as well as the OS and PFS is not different between laparoscopy and open surgery.

Comparison of Hand-assisted Laparoscopic and Open Radical Distal Gastrectomy for Obese Patients

2013 ◽  
Vol 79 (12) ◽  
pp. 1273-1278 ◽  
Author(s):  
Guang-Tan Zhang ◽  
Dong Liang ◽  
Xue-Dong Zhang
Keyword(s):  
Gastric Cancer ◽  
Blood Loss ◽  
Hospital Stay ◽  
Distal Gastrectomy ◽  
Postoperative Hospital Stay ◽  
Obese Patients ◽  
Injection Time ◽  
Open Distal Gastrectomy ◽  
Estimated Blood Loss ◽  
Wound Length

To evaluate the feasibility and safety of hand-assisted laparoscopic surgery for gastric cancer in obese patients, we compare the operative outcomes in obese patients who underwent hand-assisted laparoscopic distal gastrectomy (HALDG) and open distal gastrectomy (ODG). One hundred sixty-two obese patients with gastric cancer operated on in our department from January 2009 to December 2011 were divided into two groups: the open distal gastrectomy group (the ODG group) and the hand-assisted laparoscopic distal gastrectomy group (the HALDG group). Operative time, estimated blood loss, number of lymph node retrieval, wound length, times of analgesic injection, time to the first flatus, and postoperative hospital stay were compared between the two groups. Estimated blood loss, wound length, times of analgesic injection, time to the first flatus, and postoperative hospital stay were significantly less or shorter in the HALDG group than in the ODG group. There were no significant differences in tumor size, retrieved lymph nodes, American Joint Cancer Committee /Union Internationale Contre le Cancer staging, and resection margins between the two groups. Obesity should not be seen as a contraindication for HALDG. HALDG for obese patients is a safe, feasible, and oncologically sound procedure and has advantages over ODG.

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