scholarly journals Spade-Shaped Anastomosis after Laparoscopic Proximal Gastrectomy Using Double Suture Anchoring between the Posterior Wall of the Esophagus and the Anterior Wall of the Stomach (SPADE Operation): A Case Series

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 379
Author(s):  
Sin Hye Park ◽  
Harbi Khalayleh ◽  
Sung Gon Kim ◽  
Sang Soo Eom ◽  
Fahed Merei ◽  
...  
Keyword(s):  
Los Angeles ◽  
Anastomotic Stricture ◽  
Bile Reflux ◽  
Proximal Gastrectomy ◽  
Case Series ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Reflux Symptoms ◽  
Laparoscopic Proximal Gastrectomy ◽  
Technical Modifications

We introduced SPADE operation, a novel anastomotic method after laparoscopic proximal gastrectomy (PG). Technical modifications were performed and settled. This report aimed to demonstrate the short-term clinical outcomes after settlement. Data from 34 consecutive patients who underwent laparoscopic PG with SPADE between June 2017 and March 2020 were retrospectively reviewed. Reflux was evaluated based on the patients’ symptoms and follow-up endoscopy using Los Angeles (LA) classification and RGB Classification (Residue, Gastritis, Bile). Other complications were classified using the Clavien–Dindo method. The incidence of reflux esophagitis was 2.9% (1/34). Bile reflux was observed in six patients (17.6%), and residual food was observed in 16 patients (47.1%) in the endoscopy. Twenty-eight patients had no reflux symptoms (82.4%), while five patients (14.7%) and one patient (2.9%) had mild and moderate reflux symptoms, respectively. The rates of anastomotic stricture and ileus were 14.7% (5/34) and 11.8% (4/34), respectively. No anastomotic leakage was observed. The incidence of major complications (Clavien-Dindo grade III or higher) was 14.7%. The SPADE operation following laparoscopic PG is effective in reducing gastroesophageal reflux. Its clinical usefulness should be validated using prospective clinical trials.

scholarly journals Semi-embedded Valve Anastomosis: A new anti-reflux anastomotic method after proximal gastrectomy for adenocarcinoma of the oesophagogastric junction

2020 ◽  
Author(s):  
Baohua Wang ◽  
Yupeng Wu ◽  
Haijun Wang ◽  
Haiqiang Zhang ◽  
Liting Wang ◽  
...  
Keyword(s):  
Los Angeles ◽  
Gastroesophageal Reflux ◽  
Proximal Gastrectomy ◽  
Physiological Mechanism ◽  
Los Angeles Classification ◽  
Oesophagogastric Junction ◽  
Signed Rank ◽  
Laparoscopic Proximal Gastrectomy ◽  
New Type

Abstract Background: There is a high probability of gastroesophageal reflux after laparoscopic proximal gastrectomy for adenocarcinoma of the oesophagogastric junction (AEG). Various anti-reflux anastomotic methods are emerging in clinical practice; however, none of them have been widely accepted. We have innovated a new type of anti-reflux anastomotic method, named semi-embedded valve anastomosis. The aim of this study was to explore the feasibility and anti-reflux effect of the new anastomotic method.Methods: The clinical data of 28 patients with Siewert II AEG who were treated by semi-embedded valve anastomosis were collected. The key point of the operation is to reconstruct a simulated valve and form an anti-reflux barrier similar to the physiological mechanism. The gastroesophageal reflux disease questionnaire (GerdQ) and classification of gastroesophageal reflux under electron microscopy were used to evaluate gastroesophageal reflux after the operation.Results: The mean operative duration was 164.3±19.0 min, the median intraoperative haemorrhage volume was 65 ml, the average number of lymph nodes dissected was 23±2.6, the time for valve construction was 15.8±3.2 min, the time for anastomotic reconstruction was 35.4±4.8 min, the median time to first flatus was 3 d, and the median hospitalization duration was 12 d. There was one case of postoperative anastomotic stenosis. The GerdQ score [median (range)] was as follows: 2 (0-6), preoperation; 0 (0-8), 1 month postoperation; 2 (0-12), 3 months postoperation; and 3 (0-12), 6 months postoperation. The Wilcoxon signed-rank sum test was carried out at different times after the operation and the day before the operation, and the differences were not significant (P<0.05). There was one case of grade B gastroesophageal reflux according to the Los Angeles classification system among the gastrofibroscopic re-examination reports of 28 cases.Conclusion: Semi-embedded valve anastomosis is safe and feasible after proximal gastrectomy for Siewert II AEG and has good anti-reflux effects.

scholarly journals Comparison Of Nutrition And Quality Of Life Of Esophagogastrostomy And The Double-Tract Reconstruction After Laparoscopic Proximal Gastrectomy

2020 ◽  
Author(s):  
Bang Wool Eom ◽  
Ji Yeon Park ◽  
Ki Bum Park ◽  
Hong Man Yoon ◽  
Oh Kyoung Kwon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Anastomotic Stricture ◽  
Proximal Gastrectomy ◽  
Deficiency Anemia ◽  
Esophageal Reflux ◽  
Double Tract Reconstruction ◽  
Significant Difference ◽  
Laparoscopic Proximal Gastrectomy ◽  
Nutritional Outcomes

Abstract Purpose: This study aims to compare the nutritional outcomes and quality of life between patients who underwent esophagogastrostomy (EG) and those who underwent the double-tract reconstruction (DTR) after laparoscopic proximal gastrectomy for early gastric cancer.Methods: We retrospectively reviewed the prospectively established database of 45 patients who underwent EG with anti-reflux procedure and 58 patients who underwent the DTR after laparoscopic proximal gastrectomy between December 2013 and June 2017. Then, we compared the baseline characteristics, clinical outcomes, postoperative nutritional parameters, and quality of life (QOL) using EORTC QLQ STO-22 between the EG and DTR groups. Results: In the postoperative 1-year endoscopic findings, the incidence of esophageal reflux was higher in the EG group (17.8% vs. 3.4%, p=0.041) and there was no significant difference in anastomotic stricture. Nutritional status was assessed via body mass index, serum albumin, protein, hemoglobin, and ferritin; we found no significant differences. The incidences of iron deficiency anemia and vitamin B12 deficiency also showed no significant difference between the two groups. With regards to the quality of life, the difference values between preoperative and postoperative 1-year were evaluated; there was no significant difference between the EG with anti-reflux procedure and DTR groups. Conclusions: EG had higher incidence of esophageal reflux and similar nutritional outcomes and QOL compared with the double-tract reconstruction after laparoscopic proximal gastrectomy. Additional large-scale research is needed to evaluate the long-term functional outcomes of EG and the double-tract reconstruction.

scholarly journals Semi-embedded valve anastomosis a new anti-reflux anastomotic method after proximal gastrectomy for adenocarcinoma of the oesophagogastric junction

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Baohua Wang ◽  
Yupeng Wu ◽  
Haijun Wang ◽  
Haiqiang Zhang ◽  
Liting Wang ◽  
...  
Keyword(s):  
Los Angeles ◽  
Gastroesophageal Reflux ◽  
Proximal Gastrectomy ◽  
Physiological Mechanism ◽  
Los Angeles Classification ◽  
Oesophagogastric Junction ◽  
Signed Rank ◽  
Laparoscopic Proximal Gastrectomy ◽  
New Type

Abstract Background There is a high probability of gastroesophageal reflux after laparoscopic proximal gastrectomy for adenocarcinoma of the oesophagogastric junction (AEG). Various anti-reflux anastomotic methods are emerging in clinical practice; however, none of them have been widely accepted. We have innovated a new type of anti-reflux anastomotic method, named semi-embedded valve anastomosis. The aim of this study was to explore the feasibility and anti-reflux effect of the new anastomotic method. Methods The clinical data of 28 patients with Siewert II AEG who were treated by semi-embedded valve anastomosis were collected. The key point of the operation is to reconstruct a simulated valve and form an anti-reflux barrier similar to the physiological mechanism. The gastroesophageal reflux disease questionnaire (GerdQ) and classification of gastroesophageal reflux under electron microscopy were used to evaluate gastroesophageal reflux after the operation. Results The mean operative duration was 164.3 ± 19.0 min, the median intraoperative haemorrhage volume was 65 ml, the average number of lymph nodes dissected was 23 ± 2.6, the time for valve construction was 15.8 ± 3.2 min, the time for anastomotic reconstruction was 35.4 ± 4.8 min, the median time to first flatus was 3 d, and the median hospitalization duration was 12 d. There was one case of postoperative anastomotic stenosis. The GerdQ score [median (range)] was as follows: 2 (0–6), preoperation; 0 (0–8), 1 month postoperation; 2 (0–12), 3 months postoperation; and 3 (0–12), 6 months postoperation. The Wilcoxon signed-rank sum test was carried out at different times after the operation and the day before the operation, and the differences were not significant. There was one case of grade B gastroesophageal reflux according to the Los Angeles classification system among the gastrofibroscopic re-examination reports of 28 cases. Conclusion Semi-embedded valve anastomosis is safe and feasible after proximal gastrectomy for Siewert II AEG and has good anti-reflux effects.

scholarly journals Outcomes of laparoscopic proximal gastrectomy with jejunal interposition for proximal early gastric cancer

2018 ◽  
Vol 8 (4) ◽  
Author(s):  
Viet Trung Lam ◽  
Vo Vinh Loc Nguyen
Keyword(s):  
Gastric Cancer ◽  
Early Gastric Cancer ◽  
Proximal Gastrectomy ◽  
Case Series ◽  
Jejunal Interposition ◽  
Surgical Approaches ◽  
Safe Procedure ◽  
Female Ratio ◽  
Laparoscopic Proximal Gastrectomy

Abstract Introduction: Proximal gastrectomy is one of the modified surgical approaches for early gastric cancer located in the upper stomach instead of total gastrectomy. The preserving stomach helps for storage, digestion, and absorption of food and prevents anemia. Proximal gastrectomy with jejunal interinterposition has been reported to prevent and diminuate postoperative complications, such as reflux esophagitis and anastomotic stricture. Laparoscopic proximal gastrectomy (LPG) with jejunal interposition has been reported in the world with promising results. Aim of this study is to evaluate the feasibility and results of LPG with jejunal interposition for proximal early gastric cancer. Material and Methods: Descriptive prospective study ofconsecutive cases of laparoscopic proximal gastrectomy for early gastric cancer located in the upper stomach was conducted at Department of Digestive Surgery of Cho Ray hospital from 1/2015 to 6/2018, . Results: Of 8 cases of LPG for early gastric cancer located in the upper stomach was enrolled. Patients mean age was 55,5. Male/female ratio was 3/1. Tumor located at cardia in 7 cases and in fundus in 1 case. All the tumors were adenocarcinoma at cT1N0M0 stage. Mean operative time was 150 minutes. There was no intraoperative accident. Mean harvested lymph nodes were 5. There was no lymph node metastasis. No morbidity was noted. Mean postoperative hospital stay was 7 days. All patients tolerated well with food and have no regurgitation. With mean follow-up period of 28 months, there was no recurrence and mortality. Conclusion: Our initial case series demonstrated that LPG with jejunal interposition is a feasible, safe procedure and offering good functional and oncological outcomes. Futher follow-up time and more data should be needed to evaluate the effectiveness of this operation.

scholarly journals Laparoscopic proximal gastrectomy with hinged double flap method using knotless barbed absorbable sutures: A case series

2018 ◽  
Vol 51 ◽  
pp. 165-169 ◽  
Author(s):  
Yoshihiro Saeki ◽  
Kazuaki Tanabe ◽  
Yuji Yamamoto ◽  
Hiroshi Ohta ◽  
Ryusuke Saito ◽  
...  
Keyword(s):  
Proximal Gastrectomy ◽  
Case Series ◽  
Absorbable Sutures ◽  
Laparoscopic Proximal Gastrectomy

scholarly journals Two cases of intraoperative hemodynamic instability during combined thoracoscopic-laparoscopic surgery for esophagogastric junction carcinoma

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Makiko Tani ◽  
Yoshikazu Matsuoka ◽  
Mayu Sugihara ◽  
Ayaka Fujii ◽  
Tomoyuki Kanazawa ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Esophagogastric Junction ◽  
Intraoperative Complications ◽  
Proximal Gastrectomy ◽  
Tension Pneumothorax ◽  
Hemodynamic Instability ◽  
Laparoscopic Proximal Gastrectomy ◽  
Surgical Field ◽  
Coronary Ischemia ◽  
Thoracic And Abdominal

Abstract Background Intraoperative complications during combined thoracoscopic-laparoscopic surgery for esophagogastric junction (EGJ) carcinoma have not been reported as compared to those during surgery for esophageal carcinoma. We present two cases which had surgery-related hemodynamic instability during laparoscopic proximal gastrectomy and intra-mediastinal valvuloplastic esophagogastrostomy (vEG) with thoracoscopic mediastinal lymphadenectomy for EGJ carcinoma. Case presentation In case 1, the patient fell into hypotension with hypoxemia during laparoscopic vEG due to pneumothorax caused by entry of intraabdominal carbon dioxide. In case 2, ventricular arrythmia and ST elevation occurred during laparoscopic vEG. Pericardium retraction to secure surgical field during reconstruction compressed the coronary artery, which caused coronary malperfusion. These two events were induced by the surgical procedure, characterized by the following: (1) connection of the thoracic and abdominal cavities and (2) cardiac displacement during vEG. Conclusion These cases indicated tension pneumothorax and coronary ischemia are possible intraoperative complications specific to combined thoracoscopic-laparoscopic surgery for EGJ carcinoma.

scholarly journals 696. Bartonella quintana Endocarditis, A Case Series

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S400-S400
Author(s):  
Thomas D Dieringer ◽  
Glen Huang ◽  
Paul R Allyn ◽  
Jeffrey Klausner
Keyword(s):  
Renal Failure ◽  
Infective Endocarditis ◽  
Los Angeles ◽  
Aortic Valve ◽  
Literature Review ◽  
Case Series ◽  
The United States ◽  
Aortic Insufficiency ◽  
Homeless Population ◽  
Bartonella Quintana

Abstract Background Homelessness has been a growing issue in the United States and worldwide. Bartonella quintana, the causative agent of “Trench fever”, is a well known illness among homeless populations in urban centers. While many cases of B. quintana are self limited, the disease can have advanced presentations including endocarditis. We present a short case series of three cases of B. quintana infective endocarditis (IE) in homeless individuals in Los Angeles and review the literature of cases of B. quintana IE in the homeless population. Methods Here we report three cases of B. quintana IE encountered in homeless individuals at the University of California, Los Angeles (UCLA) hospital system. A literature review was also conducted. PubMed was searched for published cases of human IE secondary to B. quintana in homeless individuals. Results All three patients were male with ages ranging from 39 to 57 years old with a history of homelessness and alcohol use. Presentations were subacute to chronic in nature consisting of constitutional symptoms as well as a range of symptoms corresponding with heart and renal failure. Each patient was found to have varying degrees of aortic insufficiency with either identified aortic valve vegetation or valvular thickening. Diagnosis was made with a combination of Bartonella serologies and whole genome sequencing PCR. All three patient’s courses were complicated by renal failure at varying points limiting the use of gentamicin for the full treatment course. Two patients ultimately underwent aortic valve replacement due to severe aortic insufficiency and completed therapy with doxycycline and rifampin. A single patient was discharged with plan to complete doxycycline and rifampin therapy however was lost to follow up. A literature review of 10 manuscripts describing 13 cases of B. quintana IE were identified. All the patients were male and the median age was 45. Six of the cases were in Europe and eight were in North America. All cases had left sided valve involvement (10 aortic, 6 mitral, 3 both valves). No cases of right sided IE were identified. Conclusion B. quintana IE should be considered in homeless patients with a clinical presentation concerning for IE. A combination of serology and PCR testing can be useful in diagnosis of this uncommon cause of infective endocarditis. Disclosures Jeffrey Klausner, MD, MPH, Nothing to disclose

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.

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