Endoscopic management of anastomotic leakage after gastrectomy for gastric cancer: how efficacious is it?

2012 ◽  
Vol 48 (1) ◽  
pp. 111-118 ◽  
Author(s):  
Yu Jin Kim ◽  
Sung Kwan Shin ◽  
Hyun Jung Lee ◽  
Hyun Soo Chung ◽  
Yong Chan Lee ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Anastomotic Leakage ◽  
Endoscopic Management

scholarly journals Efficacy of endoscopic management for anastomotic leakage after gastrectomy in patients with gastric cancer

2021 ◽  
Author(s):  
Young-Il Kim ◽  
Jong Yeul Lee ◽  
Harbi Khalayleh ◽  
Chan Gyoo Kim ◽  
Hong Man Yoon ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Anastomotic Leakage ◽  
Cancer Patients ◽  
Endoscopic Therapy ◽  
Cancer Center ◽  
Endoscopic Management ◽  
Stent Insertion ◽  
Closure Rate ◽  
Significant Difference ◽  
Gastric Cancer Patients

Abstract Background Anastomotic leakage (AL) after gastrectomy in gastric cancer patients is associated with high mortality rates. Various endoscopic procedures are available to manage this postoperative complication. The aim of study was to evaluate the outcome of two endoscopic modalities, clippings and stents, for the treatment of AL. Patients and methods There were 4916 gastric cancer patients who underwent gastrectomy between December 2007 and January 2016 at the National Cancer Center, Korea. A total of 115 patients (2.3%) developed AL. Of these, 85 patients (1.7%) received endoscopic therapy for AL and were included in this retrospective study. The endpoints were the complete leakage closure rates and risk factors associated with failure of endoscopic therapy. Results Of the 85 patients, 62 received endoscopic clippings (with or without detachable snares), and 23 received a stent insertion. Overall, the complete leakage closure rate was 80%, and no significant difference was found between the clipping and stent groups (79.0% vs. 82.6%, respectively; P = 0.89). The complete leakage closure rate was significantly lower in the duodenal and jejunal stump sites (60%) than esophageal sites (86.1%) and gastric sites (94.1%; P = 0.026). The multivariate analysis showed that stump leakage sites (adjusted odds ratio [aOR], 4.51; P = 0.031) and the presence of intra-abdominal abscess (aOR, 4.92; P = -0.025) were associated with unsuccessful leakage closures. Conclusions Endoscopic therapy using clippings or stents is an effective method for the postoperative management of AL in gastric cancer patients. This therapy can be considered a primary treatment option due to its demonstrated efficacy, safety, and minimally invasive nature.

scholarly journals Effectiveness of a Novel Covered Stent without External Thread Fixation for Anastomotic Leakage after Total or Proximal Gastrectomy for Gastric Cancer

Cancers ◽  
2021 ◽  
Vol 13 (15) ◽  
pp. 3720
Author(s):  
Young-Il Kim ◽  
Chan Gyoo Kim ◽  
Jong Yeul Lee ◽  
Il Ju Choi ◽  
Bang Wool Eom ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Anastomotic Leakage ◽  
Stent Placement ◽  
Proximal Gastrectomy ◽  
Stent Migration ◽  
Covered Stent ◽  
Double Layers ◽  
Stent Group ◽  
Hospitalization Period ◽  
Gastric Cancer Patients

A thread-fix stent entails long hospitalization and patient discomfort. We aimed to evaluate the efficacy of a novel stent with silicone-covered outer double layers without external fixation (Beta stent) for anastomotic leakage after total or proximal gastrectomy. The outcomes were compared between gastric cancer patients who underwent stent placement using a thread-fix stent between 2014 and 2015 (Thread-Fix Group) and those who received a Beta stent in the succeeding period until October 2018 (Beta Stent Group). The Beta Stent Group (n = 14) had a significantly higher leakage healing rate by the first stent placement (92.9% vs. 53.8%; p = 0.021) and had a shorter hospitalization period (median: 16 days vs. 28 days; p = 0.037) than the Thread-Fix Group (n = 13). Further, 50% of the Beta stent patients received outpatient management until stent removal. Stent maintenance duration was significantly longer in the Beta Stent Group (median, 28 days vs. 18 days; p = 0.006). There was no significant between-group difference in stent-related complications except for stent migration (7.1% (Beta Stent Group) vs. 0% (Thread-Fix Group), p = 0.326). In conclusion, the Niti-S Beta stent is an effective treatment for anastomotic leakage from total or proximal gastrectomy for gastric cancer. Stent maintenance is possible without hospitalization.

scholarly journals Double layer versus Single layer Gastro-intestinal anastomosis in gastric cancer surgery in Mymensingh Medical College Hospital

2013 ◽  
Vol 2 (2) ◽  
pp. 30-34
Author(s):  
S Rahman ◽  
MA Khair ◽  
F Khanam ◽  
S Haque ◽  
MM Hoque ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Wound Infection ◽  
Anastomotic Leakage ◽  
Double Layer ◽  
Single Layer ◽  
Abdominal Sepsis ◽  
Pelvic Abscess ◽  
Cancer Surgery ◽  
College Hospital ◽  
Gastric Cancer Surgery

Introduction: In gastric cancer surgery, gastrojejunostomy is one of the most important procedures. Anastomosis between different parts of the stomach and the intestine is a basic technical component in all gastrointestinal procedure. Backgrounds and aims: This study evaluated complications of gastrojejunostomy in gastric cancer surgery with two methods: single-layer and double-layer anastomosis. Materials and methods: This study was carried out in the department of surgery in Mymensingh Medical College Hospital from January 1, 2009 to December 31, 2012. 100 patients with carcinoma stomach who needed gastrojejunostomy were included in this study. These patients with average age of 43.22 years were divided in two groups (50 in each group); single-layer and double-layer anastomosis. In single-layer anastomosis gastrojejunostomy was performed in interrupted method with absorbable suture (2/0 vicryl). Double-layer anastomosis was carried out with continuous suture (2/0 silk, 2/0 catgut). Possible post-operative complications like anastomotic leakage, pelvic abscess, abdominal sepsis, anastomotic stenosis and wound infection were evaluated. Results: In the single-layer group, 4 patients (8%) developed anastomotic leakage, wound infection and only 2 patients (4%) developed abdominal sepsis, pelvic abscess and anastomotic bleeding. No patient developed anastomotic stricture. In double-layer group, 2 (4%) patients developed anastomotic leakage, only 1 (2%) patient had pelvic abscess, abdominal sepsis and anastomotic bleeding but wound infection in 2 (4%) patients. Conclusion: Gastrojejunostomy with single-layer hand-sewn suture technique is safe without serious complications in comparison to double-layer suture technique. More-over operation time is less and cost is less in single-layer method.DOI: http://dx.doi.org/10.3329/cbmj.v2i2.16695 Community Based Medical Journal 2013 July: Vol.02 No 02: 30-34

An update in endoscopic management of gastric cancer

2011 ◽  
Vol 27 (6) ◽  
pp. 576-582 ◽  
Author(s):  
Alexandra Retana ◽  
Taryn Silverstein ◽  
Wahid Wassef
Keyword(s):  
Gastric Cancer ◽  
Endoscopic Management

The advantages of circular stapling instrument compared with Albert-Lembert suture for anastomosis of Billroth I gastrectomy for gastric cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 14104-14104
Author(s):  
H. Imamura ◽  
H. Furukawa ◽  
M. Tatsuta ◽  
T. Kishimoto ◽  
K. Yamamoto ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Anastomotic Leakage ◽  
Distal Gastrectomy ◽  
Circular Stapler ◽  
Purse String ◽  
Billroth I ◽  
Anastomotic Bleeding ◽  
Group A ◽  
Group B ◽  
Linear Cutter

14104 Background: In Japan, reconstruction with Billroth I using Albert-Lembert suture had been usually performed in distal gastrectomy for gastric cancer. However stapling instruments have within recent years gained wide acceptance not only in total gastrectomy but also in distal gastrectomy. We have introduced circular stapling instrument for anastomosis reconstructed with Billroth I since June 2001. Methods: 111 and 222 patients with gastric cancer underwent distal gastrectomy reconstructed with Billroth I using Albert-Lembert suture from June 1999 to May 2001 (Group A) and using circular stapling instrument from June 2001 to December 2003 (Group B) for anastmosis in our institute, respectively. Albert-Lembert suture was performed as end-to-end gastroduodenostomy followed by resection of proximal line stapled across with liner cutter instrument. The procedure of anastomosis using circular stapling instrument was as followed; the distal duodenum was clamped with the purse-string instrument, divided proximally, the anvil was attached, the purse-string was tied down, the circular stapler without anvil was inserted through a gastrotomy, brought out through a stab wound at the anastomosis site, the instrument was closed and fired, and gastrectomy involving the site of gastrotomy was closed with linear cutter instrument. The followed-up periods of all patients from surgery were more than 2 years. We retrospectively compared the incidence of anastomosis-related complications within 2 years from surgery consisting of anastomotic bleeding, leakage, and stenosis. P-values were calculated statistically using χ2-test. Results: Anastomotic bleeding occurred in 1 (0.45%) patient of Group B, but in none of Group A (P=0.48). Anastomotic leakage occurred in 2 patients (1.80%) of Group A, but in none of Group B (P=0.045). Anastomotic stenosis occurred in 2 patients (0.90%) of Group B, but in none of Group A (P=0.32). All complications were recovered and all patients left hospital in the safety. Conclusions: Our data indicated that circular stapling instrument for anastomosis of Billroth I gastrectomy for gastric cancer significantly reduced the incidence of anastomotic leakage compared with Albert-Lembert suture. No significant financial relationships to disclose.

Safety of double and a half-layered esophagojejunal anastomosis in total gastrectomy with gastric cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16563-e16563
Author(s):  
Pengfei Ma ◽  
Yuzhou Zhao ◽  
Xijie Zhang
Keyword(s):  
Gastric Cancer ◽  
Postoperative Complications ◽  
Blood Loss ◽  
Anastomotic Leakage ◽  
Total Gastrectomy ◽  
Operating Time ◽  
New Method ◽  
Control Group ◽  
Observation Group ◽  
Esophagojejunal Anastomosis

e16563 Background: Esophageal jejunal anastomotic fistula is still one of the serious postoperative complications of gastric cancer, the incidence was 1% ~ 16.5%. The aim of this study was to evaluate the safety of double and a half layered esophagojejunal anastomosis in total gastrectomy. Methods: The new method was called double and a half layered esophagojejunal anastomosis: esophagojejunal anastomosis was performed with a tubular stapler, then the anastomosis was reinforced by absorbable suture (Full-layer continuous suture, slurry muscularis embedding). The new method was used in observation group (n = 295). In the control group(n = 469),the esophagojejunal anastomosis was performed with a tubular stapler, then reinforced by intermittent suture with absorbable sutures. Data analysis including operating time, blood loss, anastomosis time, types and cases of postoperative complications, and postoperative hospitalization time. Results: The data of 764 patients who performed radical gastrectomy between May 2015 and May 2019 were analyzed retrospectively. 1.Surgery situations: The operating time (140.66±26.96 min vs 139.61±22.75min, t= 0.581, P> 0.05) blood loss (200.61±111.03ml vs214.45±114.09ml, t= -1.481, P> 0.05), anastomosis time (20.44±4.31min vs19.92±4.58min, t= 1.573, P> 0.05), postoperative hospitalization time (15.35±6.46 d vs15.89±5.58d, t= -1.229, P> 0.05) .2. Postoperative situations: the rates of anastomotic complications in observation group was 1.69% (5/295) and 4.69% (22/469) in control group, with a statistically significant difference between two groups( χ2 = 4.768, P< 0.05). The rates of anastomotic leakage in observation group was lower than that in the control group 1.02% (3/295) vs 3.41% (16/469) ( χ2 = 4.282, P< 0.05) . The severity of anastomotic leakage, anastomotic stenosis, anastomotic bleeding were no statistically significant differences between two groups( χ 2= 2.030,1.261,0.075, P> 0.05). Total postoperative complications: 101 cases (34.24%) in the observation group, 14 cases (4.75%) with severe complications, and 1 case death. 151 cases (32.2%) in the control group, 34 cases (7.25%) with serious complications, and 2 cases death ( χ2 = 0.838, Z = -1.465, P > 0.05). Conclusions: Double and a half layered esophagojejunal anastomosis is safe and feasible in total gastrectomy, which can reduce the incidence of anastomosis complications.

Safe management of anastomotic leakage after gastric cancer surgery with enteral nutrition via a nasointestinal tube

2012 ◽  
Vol 397 (5) ◽  
pp. 737-744 ◽  
Author(s):  
Yoshimasa Akashi ◽  
Naoki Hiki ◽  
Souya Nunobe ◽  
Xiaohua Jiang ◽  
Toshiharu Yamaguchi
Keyword(s):  
Gastric Cancer ◽  
Enteral Nutrition ◽  
Anastomotic Leakage ◽  
Cancer Surgery ◽  
Gastric Cancer Surgery ◽  
Safe Management ◽  
Nasointestinal Tube
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