FREQUENT OCCURRENCE OF ANASTOMOTIC STENOSIS FOLLOWING COLON INTERPOSITION RECONSTRUCTION AFTER TOTAL GASTRECTOMY

Abstract Background: Recently, due to increasing reports of stenosis after esophagojejunostomy created using circular staplers and a transorally inserted anvil (OrVilTM) following laparoscopic proximal gastrectomy (LPG) and total gastrectomy (LTG), linear staplers are being used instead. We investigated our preventive procedure for esophagojejunostomy stenosis performed using circular staplers.Methods Since the anastomotic stenosis is considered to be mainly caused by tension in the esophageal and jejunal stumps at the anastomotic site, we have been performing procedures to relieve this tension, by cutting off the rubber band and pushing the shaft of the circular stapler toward the esophageal side, since July 2015. We retrospectively compared the incidence of anastomotic stenosis in cases of LPG and LTG performed before July 2015 (early phase, 30 cases) versus those performed after this period (later phase, 22 cases).Results Comparison of the incidence of anastomotic stenosis according to the type of surgery, LPG or LTG, and between the two time periods versus all cases, indicated a significantly lower incidence in the later phase than in the early phase (4.5% vs. 26.7%, p<0.05), especially for LPG (0% vs. 38.5%, p<0.05).Conclusions It is possible to use a circular stapler during laparoscopic esophagojejunostomy, as with open surgery, if steps to reduce tension on the anastomotic site are undertaken. These procedures will contribute to the spread of safe and simple laparoscopic anastomotic techniques.

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A case of anastomotic stenosis and fistula due to suture failure following total gastrectomy successfully managed using endoscopic therapy

Progress of Digestive Endoscopy ◽

10.11641/pde.87.1_72 ◽

2015 ◽

Vol 87 (1) ◽

pp. 72-75

Author(s):

Satoshi Adachi ◽

Toshiharu Kakimoto ◽

Hitoshi Kanda ◽

Toshikazu Yamaguchi

Keyword(s):

Total Gastrectomy ◽

Endoscopic Therapy ◽

Anastomotic Stenosis ◽

Suture Failure

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Preventive procedure for stenosis after esophagojejunostomy using a circular stapler and transorally inserted anvil (OrVil™) following laparoscopic proximal gastrectomy and total gastrectomy involving reduction of anastomotic tension

BMC Surgery ◽

10.1186/s12893-021-01054-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Eiji Nomura ◽

Hajime Kayano ◽

Takatoshi Seki ◽

Rin Abe ◽

Hisamichi Yoshii ◽

...

Keyword(s):

Total Gastrectomy ◽

Early Phase ◽

Proximal Gastrectomy ◽

Circular Stapler ◽

Rubber Band ◽

Anastomotic Stenosis ◽

Anastomotic Site ◽

Laparoscopic Proximal Gastrectomy ◽

Later Phase ◽

Circular Staplers

Abstract Background Recently, due to increasing reports of stenosis after esophagojejunostomy created using circular staplers and a transorally inserted anvil (OrVil™) following laparoscopic proximal gastrectomy (LPG) and total gastrectomy (LTG), linear staplers are being used instead. We investigated our preventive procedure for esophagojejunostomy stenosis following use of circular staplers. Methods Since the anastomotic stenosis is considered to be mainly caused by tension in the esophageal and jejunal stumps at the anastomotic site, we have been performing procedures to relieve this tension, by cutting off the rubber band and pushing the shaft of the circular stapler toward the esophageal side, since July 2015. We retrospectively compared the incidence of anastomotic stenosis in cases of LPG and LTG performed before July 2015 (early phase, 30 cases) versus those performed after this period (later phase, 22 cases). Results Comparison of the incidence of anastomotic stenosis according to the type of surgery, LPG or LTG, and between the two time periods versus all cases, indicated a significantly lower incidence in the later phase than in the early phase (4.5 vs. 26.7%, p < 0.05), especially for LPG (0 vs. 38.5%, p < 0.05). Conclusions It is possible to use a circular stapler during laparoscopic esophagojejunostomy, as with open surgery, if steps to reduce tension on the anastomotic site are undertaken. These procedures will contribute to the spread of safe and simple laparoscopic anastomotic techniques.

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Postoperative nutritional outcomes and quality of life-related complications of proximal versus total gastrectomy for upper-third early gastric cancer: a meta-analysis

Scientific Reports ◽

10.1038/s41598-020-78458-0 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Inhyeok Lee ◽

Youjin Oh ◽

Shin- Hoo Park ◽

Yeongkeun Kwon ◽

Sungsoo Park

Keyword(s):

Quality Of Life ◽

Gastric Cancer ◽

Early Gastric Cancer ◽

Total Gastrectomy ◽

Meta Analysis ◽

Anastomotic Stenosis ◽

Operative Outcomes ◽

Upper Third ◽

Nutritional Outcomes

AbstractAlthough proximal gastrectomy (PG) provides superior nutritional outcomes over total gastrectomy (TG) in upper-third early gastric cancer (EGC), surgeons are reluctant to perform PG due to the high rate of postoperative reflux. This meta-analysis aimed to comprehensively compare operative outcomes, nutritional outcomes, and quality of life-related complications between TG and PG performed with esophagogastrostomy (EG), jejunal interposition, or double-tract reconstruction (DTR) to reduce reflux after PG. After searching PubMed, Embase, Medline, and Web of Science databases, 25 studies comparing PG with TG in upper-third EGC published up to October 2020 were identified. PG with DTR was similar to TG regarding operative outcomes. Patients who underwent PG with DTR had less weight reduction (weighted mean difference [WMD] 4.29; 95% confidence interval [0.51–8.07]), reduced hemoglobin loss (WMD 5.74; [2.56–8.93]), and reduced vitamin B12 supplementation requirement (odds ratio [OR] 0.06; [0.00–0.89]) compared to patients who underwent TG. PG with EG caused more reflux (OR 5.18; [2.03–13.24]) and anastomotic stenosis (OR 3.94; [2.40–6.46]) than TG. However, PG with DTR was similar to TG regarding quality of life-related complications including reflux, anastomotic stenosis, and leakage. Hence, PG with DTR can be recommended for patients with upper-third EGC considering its superior postoperative nutritional outcomes.

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Laparoscopic Proximal Gastrectomy Versus Laparoscopic Total Gastrectomy for Proximal Gastric Cancer: A Systematic Review and Meta−Analysis

Frontiers in Oncology ◽

10.3389/fonc.2020.607922 ◽

2021 ◽

Vol 10 ◽

Author(s):

Peirong Tian ◽

Yang Liu ◽

Shibo Bian ◽

Mengyi Li ◽

Meng Zhang ◽

...

Keyword(s):

Gastric Cancer ◽

Blood Loss ◽

Lymph Nodes ◽

Total Gastrectomy ◽

Reflux Esophagitis ◽

Proximal Gastrectomy ◽

Laparoscopic Total Gastrectomy ◽

Anastomotic Stenosis ◽

Proximal Gastric Cancer ◽

Laparoscopic Proximal Gastrectomy

BackgroundTo compare laparoscopic proximal gastrectomy (LPG) and laparoscopic total gastrectomy (LTG) with regard to outcomes, including efficacy and safety, in patients with proximal gastric cancer.MethodsOriginal English-language articles comparing LPG and LTG for proximal gastric cancer up to November 2019 were systematically searched in the Embase, PubMed, Cochrane Library, Web of Knowledge, and ClinicalTrials.gov databases by two independent reviewers. Our main endpoints were surgery-related features (operation time, blood loss, harvested lymph nodes, and postoperative hospital stay), postoperative complications (anastomotic leakage, anastomotic bleeding, anastomotic stenosis, and reflux esophagitis), and oncologic outcomes (5-year overall survival and recurrent cancer).ResultsFourteen studies including a total of 1,282 cases (510 LPG and 772 LTG) were enrolled. Fewer lymph nodes were harvested (WMD = −13.33, 95% CI: −15.66 to −11.00, P < 0.00001) and more postoperative anastomotic stenosis (OR = 2.03, 95% CI: 1.21 to 3.39, P = 0.007) observed in LPG than LTG. There were no significant differences in other explored parameters between the two methods. However, based on a subgroup analysis of digestive tract reconstruction, LPG with esophagogastrostomy (LPG-EG) had shorter operative time (WMD = −42.51, 95% CI: −58.99 to −26.03, P < 0.00001), less intraoperative blood loss (WMD = −79.52, 95% CI: −116.63 to −42.41, P < 0.0001), and more reflux esophagitis (OR = 3.92, 95% CI: 1.56 to 9.83, P = 0.004) than was observed for LTG. There was no difference between LPG performed with the double tract anastomosis/double-flap technique (DT/DFT) and LTG.ConclusionLPG can be performed as an alternative to LTG for proximal gastric cancer, especially LPG-DT/DFT, with comparable safety and efficacy.

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Pernicious Anemia Following Total Gastrectomy for Giant Hypertrophy of the Gastric Rugae (Menetrier’s Disease)

Gastroenterology ◽

10.1016/s0016-5085(19)35271-0 ◽

1960 ◽

Vol 39 (3) ◽

pp. 347-350 ◽

Cited By ~ 2

Author(s):

Earl E. Gambill ◽

Donald C. Campbell ◽

Donald C. Balfour ◽

John M. Waugh ◽

Malcolm B. Dockerty

Keyword(s):

Pernicious Anemia ◽

Total Gastrectomy ◽

Menetrier’S Disease ◽

Ménétrier's Disease ◽

Menetrier's Disease

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Endovascular stent-graft treatment for graft-vein anastomotic stenosis in haemodialysis patients with arteriovenous grafts

VASA ◽

10.1024/0301-1526/a000470 ◽

2015 ◽

Vol 44 (6) ◽

pp. 466-472 ◽

Cited By ~ 1

Author(s):

Chia-Hsun Lin ◽

Yen-Yang Chen ◽

Chai-Hock Chua ◽

Ming-Jen Lu

Keyword(s):

Risk Factors ◽

Stent Graft ◽

Target Lesion ◽

Primary Patency ◽

Anastomotic Stenosis ◽

Secondary Patency ◽

Endovascular Stent ◽

Stent Grafts ◽

Venous Anastomosis ◽

Arteriovenous Grafts

Abstract. Background: In this study, we investigated the patency of endovascular stent grafts in haemodialysis patients with arteriovenous grafts, the modes of patency loss, and the risk factors for re-intervention. Patients and methods: Haemodialysis patients with graft-vein anastomotic stenosis of their arteriovenous grafts who were treated with endovascular stent-grafts between 2008 and 2013 were entered into this retrospective study. Primary and secondary patency, modes of patency loss, and risk factors for intervention were recorded. Results: Cumulative circuit primary patency rates decreased from 40.0 % at 6 months to 7.3 % at 24 months. Cumulative target lesion primary patency rates decreased from 72.1 % at 6 months to 22.0 % at 24 months. Cumulative secondary patency rates decreased from 81.3 % at 12 months to 31.6 % at 36 months. Patients with a history of cerebrovascular accident had a significantly higher risk of secondary patency loss, and graft puncture site stenosis jeopardised the results of stent-graft treatment. Conclusions: Our data can help to improve outcomes in haemodialysis patients treated with stent-grafts for venous anastomosis of an arteriovenous graft.

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