Alimentary tract obstruction attributed to use of barbed suture for double tract reconstruction after robot-assisted proximal gastrectomy: a case report

Background Anastomotic stenosis following esophagojejunostomy reconstruction by the overlap method with absorbable barbed sutures occurs only rarely in patients who have undergone laparoscopic surgery. We report anastomotic stenosis by the overlap method that we attributed to the lack of tactile sensation during robot-assisted surgery. Case presentation An 83-year-old man underwent robot-assisted laparoscopic proximal gastrectomy and lymph node dissection at our hospital for treatment of gastric cancer. Double tract reconstruction followed with side-to-side esophagojejunostomy (overlap method) performed with an endoscopic linear stapler. On completion of the anastomosis, the enterotomy was closed under robotic assistance with absorbable barbed suture. Once solid foods were introduced, the patient had difficulty swallowing and felt as though his digestive tract was stopped up. When upper gastrointestinal endoscopy was performed, we found the anastomotic lumen to be coated with food residue. After rinsing off the residue with water, we could see barbed suture protruding into the anastomotic lumen that had become entangled upon itself, which explained how the food residue had accumulated. We cut the entangled suture under endoscopic visualization using a loop cutter. Conclusion This case highlights a stricture caused by insufficiently tensioning barbed suture, which subsequently protruded into the anastomotic lumen and became entangled upon itself. We believe this occurrence was associated with the lack of tactile sensation in robot-assisted surgery.

Surgical outcomes of two different reconstruction routes for esophagectomy in esophageal cancer patients: a meta-analysis

Summary To evaluate the effects of two different reconstruction routes (the posterior mediastinal route (PR) and the retrosternal route (RR)) on the surgical outcomes of patients after esophagectomy for esophageal carcinoma. PubMed, Embase, Web of Science and Scopus were searched from database inception to March 2021. Randomized controlled trials (RCTs) and case–control trials on the surgical outcomes of patients undergoing esophagectomy via one of the two routes were included. RevMan 5.3 software was used for the meta-analysis. In total, 19 studies were included, 8 were RCTs and 11 were case–control studies. The meta-analysis showed that among the case–control trials, the PR had reduced rates of anastomotic leakage [odds ratio (OR) = 0.56, 95% confidence interval (CI) (0.43, 0.74), P < 0.01]. In addition, it had reduced rates of anastomotic stenosis [OR = 0.42, 95% CI (0.30, 0.59), P < 0.01] and pulmonary complications [OR = 0.63, 95% CI (0.47, 0.84), P < 0.01]. However, there was no significant difference in cardiac complications [RCTs, relative risk (RR) = 0.57, 95% CI (0.29, 1.11), P = 0.10; case–control trials, OR = 1.06, 95% CI (0.70, 1.62), P = 0.78] or postoperative mortality [RCTs, RR = 0.47, 95% CI (0.19, 1.16), P = 0.10; case–control trials, OR = 0.68, 95% CI (0.32, 1.44), P = 0.31]. Compared with the RR, the PR had reduced rates of anastomotic leakage, anastomotic stenosis and pulmonary complications.

The timing of oesophageal dilatations in anastomotic stenosis after one-stage anastomosis for congenital oesophageal atresia

Background In infants with congenital oesophageal atresia, anastomotic stenosis easily occurs after one-stage oesophageal anastomosis, leading to dysphagia. In severe cases, oesophageal dilatation is required. In this paper, the timing of oesophageal dilatation in infants with anastomotic stenosis was investigated through retrospective data analysis. Methods The clinical data of 107 infants with oesophageal atresia who underwent one-stage anastomosis in our hospital from January 2015 to December 2018 were retrospectively analysed. Data such as the timing and frequency of oesophageal dilatation under gastroscopy after surgery were collected to analyse the timing of oesophageal dilatation in infants with different risk factors. Results For infants with refractory stenosis, the average number of dilatations in the early dilatation group (the first dilatation was performed within 6 months after the surgery) was 5.75 ± 0.5, which was higher than the average of 7.40 ± 1.35 times in the normal dilatation group (the first dilatation was performed 6 months after the surgery), P = 0.038. For the infants with anastomotic fistula and anastomotic stenosis, the number of oesophageal dilatations in the early dilatation group was 2.58 ± 2.02 times, which was less than the 6.38 ± 2.06 times in the normal dilatation group, P = 0.001. For infants with non-anastomotic fistula stenosis, early oesophageal dilatation could not reduce the total number of oesophageal dilatations. Conclusion Starting to perform oesophageal dilatation within 6 months after one-stage anastomosis for congenital oesophageal atresia can reduce the required number of dilatations in infants with postoperative anastomotic fistula and refractory anastomotic stenosis.

Clinical Efficacy of Endoscopic Technique in the Treatment of Gastrointestinal Anastomotic Complications: a Retrospective Study

Background: To evaluate the safety and effectiveness of endoscopic technique in treating postoperative anastomotic complications of digestive tract. Methods: Clinical data of patients received endoscopic treatment in our hospital due to anastomotic complications after gastrointestinal surgery from January 2015 to December 2018 were collected for retrospective analysis. Endoscopic intervention was used for postoperative anastomotic complications in all the included cases. The time of the intervention measures, laboratory examination, incidence of complications and postoperative follow-up were observed and analyzed.Results: A total of 88 patients were included in the study, including 43 patients with anastomotic stenosis,22 with anastomotic obstruction,23 with anastomotic fistula. For anastomotic obstruction patients, 36 patients with anastomosis were successfully treated with endoscopy. For anastomotic obstruction patients, 18 cases were successfully treated with endoscopy. For anastomotic fistula patients, 21 cases were successfully treated with endoscopy.During follow-up after the endoscopic procedure, 4 patients with anastomotic stenosis needed endoscopic intervention again, 3 cases undertook surgical intervention and 2 cases maintained acceptable defecation function by intermittent dilation with a plastic dilater. one patients with anastomotic obstruction had stent displacement and was removed. For the anastomotic fistula patients,one case relapsed and then underwent endoscopic intervention again, three cases converted to surgical intervention.Preoperative and postoperative blood biochemical examination had no significant statistical significanceConclusion: Endoscopic treatment of anastomosis complications was effective for some of the patients, especially for those with anastomosis stenosis or stricture, considering its saftey, it might be the first choice for anastomosis complications.