The ways to improve the results of the pylorus-preserving gastric resection

Objective. To enhance the results efficacy of the pylorus-preserving gastric resection. Materials and methods. Retrospective estimation of results of the pylorus-preserving gastric resection was conducted while various operative procedures application in 64 patients, ageing 34-75 yrs old. The average age of the patients was (52.5 ± 6.2) yrs old. Results. The patients were divided into two Groups. In Group I (n = 36) the pylorus-preserving gastric resection was performed in accordance to conventional procedure - without identification of infrapyloric arteries and veins as well as vagal branches, innervating pyloric sphincter. In Group II (n = 28) accurate dissection was performed, using special optic technique for preservation of all vascular structures, going to pylorus. Conclusion. The pylorus-preserving gastric resection owes several advantages, because it prevents the postgastrectomy syndrome development.

The three muscle layers in the pyloric sphincter and their possible function during antropyloroduodenal motility

This study was conducted to determine the muscular arrangement of the human pyloric sphincter using a comprehensive approach that involved microdissection, histology, and microcomputed tomography (micro‐CT). The stomachs of 80 embalmed Korean adult cadavers were obtained. In all specimens, loose muscular tissue of the innermost aspect of the sphincter wall ran aborally, forming the newly found inner longitudinal muscle bundles, entered the duodenum, and connected with the nearby circular bundles. In all specimens, approximately one-third of the outer longitudinal layer of the sphincter entered its inner circular layer, divided the circular layer into several parts, and finally connected with the circular bundles. Anatomical findings around the sphincter were confirmed in micro-CT images. The sphincter wall comprised three layers: an inner layer of longitudinal bundles, a middle layer of major circular and minor longitudinal bundles, and an outer layer of longitudinal bundles. The stomach outer longitudinal bundles were connected to the sphincter circular bundles. The inner longitudinal bundles of the sphincter were connected to the adjacent circular bundles of the duodenum.

The pocket-creation method facilitates endoscopic submucosal dissection of gastric neoplasms involving the pyloric ring

Background and study aims Endoscopic submucosal dissection (ESD) of superficial gastric lesions involving the pyloric ring is difficult. The pocket-creation method (PCM) with a small-caliber-tip transparent hood can overcome this difficulty by compressing the pyloric sphincter applying both traction and counter-traction. The aim of this study is to clarify the usefulness of the PCM for ESD of superficial gastric neoplasms involving the pyloric ring compared to the conventional method (CM). Patients and methods From October 2006 to August 2019, 66 gastric lesions requiring duodenal submucosal dissection beyond the pyloric ring in 66 patients were resected. The CM was mainly performed in the first period (CM group, n = 46) and the PCM in the second period (PCM group, n = 20). We retrospectively reviewed their medical records. Results Although no significant differences were observed in en bloc resection rates between the two groups, the PCM group had a significantly higher R0 resection rate than the CM group (P = 0.047). There were no holes in resected specimens in the PCM group while three specimens in the CM group had a hole. The dissection speed in the PCM group tended to be higher than in the CM group, although it did not reach statistical significance (P = 0.148). No significant differences were observed for the incidence of adverse events. Conclusions This is the first study reporting the advantages of the PCM over the CM for ESD of gastric lesions involving the pyloric ring. We believe that the PCM is an effective strategy to compress the pyloric sphincter and facilitates R0 resection.

The effect of the distance from the pyloric sphincter and size of the calibration tube on ­postoperative outcomes of the laparoscopic sleeve gastrectomy

Aim. To study of the effect of the diameter of the calibration tube and the distance from the pyloric sphincter on the outcomes of the laparoscopic sleeve gastrectomy. Methods. The study included 945 (915 women) patients with a body mass index 51.59 kg/m2. The average age of the patients was 53.58.5 years. The patients were divided into 2 groups by the type of laparoscopic surgery: in the first group (n=463), a 36 Fr calibration tube was used, the distance from the pyloric sphincter was 46 cm; in the second group (n=482), a 32 Fr calibration tube was used, the distance from the pyloric sphincter was 23 cm. The main comparison criteria was the percentage of body weight loss in the first 6 and 12 months, and an additional comparison criteria was the of concomitant diseases progress in postoperative and the existence of complications. Results. A comparative analysis showed that the first group in the first 6 months lost 593% of its initial body weight, while in 12 months 714%; in the second group, 733 and 873% of the initial weight, respectively. Concomitant diseases in the first group decreased by 7080% by the 6th month after surgery and by 8596% by the 12th month. In the 2nd group, similar remission with improvement was between 84 and 94% at the 6th month, and remained the same at the 12th month. Conclusion. The results of the study show that in laparoscopic sleeve gastrectomy with a calibration tube diameter 32 Fr and a distance of 23 cm from the pyloric sphincter, compared to a calibration tube diameter 36 Fr or more and a distance of 46 cm from the pyloric sphincter, a body weight loss faster and more effective with earlier remission of concomitant diseases, while the number of complications is comparable.