Duodenal Stump Reinforcement with Purse-string Suture in Distal Gastrectomy under Laparoscope Combined with Uncut Roux-en-Y Reconstruction in Patients with Gastric Cancer

Background: This study aimed to compare patient outcomes after laparoscopic distal gastrectomy with uncut Roux-en-Y reconstruction for gastric cancer between a group who underwent a duodenal stump reinforcement procedure and those who did not.Methods: Data from 233 patients with gastric cancer (GC) undergoing distal gastrectomy under laparoscope combined with uncut Roux-en-Y reconstruction were retrospectively investigated. Patients were divided into two groups. The non-reinforcement group (NR) underwent surgery from June 2014 to March 2015 with no reinforcement of the duodenal stump (n=54) and the reinforcement group (R) underwent surgery from April 2015 to June 2018 with reinforcement of the duodenal stump (n=179). In group R, the duodenum was divided using an endoscope-assisted linear stapler, which was reinforced by a purse-string suture along the duodenal staple line. Results: Duodenal stump leakage was observed in 2 patients from group NR (3.7%), while no duodenal stump leakage or fistula was detected in group R. In addition, no significant difference was observed in the patient characteristics between group NR and R.Conclusions: The incidence of duodenal stump leakage can be reduced by reinforcement with a purse-string suture.

Duodenal Stump Reinforcement with Purse-string Suture in Distal Gastrectomy under Laparoscope Combined with Uncut Roux-en-Y Reconstruction in Patients with Gastric Cancer

Objective: This study aimed to compare patient outcomes after laparoscopic distal gastrectomy with uncut Roux-en-Y reconstruction for gastric cancer between a group who underwent a duodenal stump reinforcement procedure and those who did not.Methods: Data from 233 patients with gastric cancer (GC) undergoing distal gastrectomy under laparoscope combined with uncut Roux-en-Y reconstruction were retrospectively investigated. Patients were divided into two groups. The non-reinforcement group (NR) underwent surgery from June 2014 to March 2015 with no reinforcement of the duodenal stump (n=54) and the reinforcement group (R) underwent surgery from April 2015 to June 2018 with reinforcement of the duodenal stump (n=179). In group R, the duodenum was divided using an endoscope-assisted linear stapler, which was reinforced by a purse-string suture along the duodenal staple line. Results: Duodenal stump leakage was observed in 2 patients from group NR (3.7%), while no duodenal stump leakage or fistula was detected in group R. In addition, no significant difference was observed in the patient characteristics between group NR and R.Conclusions: The incidence of duodenal stump leakage can be reduced by reinforcement with a purse-string suture.

Feasibility and Safety of Laparoscopy-Assisted Subtotal Gastrectomy for Gastric Cancer Invading the Upper Stomach

This study evaluated the feasibility and safety of laparoscopy-assisted subtotal gastrectomy preserving a minimal remnant stomach for clinical T1 gastric cancer invading the upper stomach. Forty-three consecutive patients who underwent laparoscopy-assisted subtotal gastrectomy preserving a minimal remnant stomach were examined. In addition to the conventional laparoscopy-assisted distal gastrectomy, some short and posterior gastric arteries were resected. A minimal remnant stomach-jejunum anastomosis was made by using a circular stapler with regular anvil or transoral anvil. Transoral anvil was selected in 19 patients, and regular anvil was used in 24 patients. The median operation time was 288 minutes, and the median blood loss was 50 mL. Conversion to open surgery was required in 2 patients due to bleeding. No patient required conversion to open surgery due to the difficulty of the anastomosis. Nine patients developed postoperative complications, including grade 3 duodenal stump leakage in 1 patient and grade 2 anastomotic bleeding in another patient. No mortality was observed. Laparoscopy-assisted subtotal gastrectomy preserving a minimal remnant stomach is safe and feasible for early gastric cancer invading the upper stomach.