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Suzuki Y, Nomura K, Matsui A, Kikuchi D, Hoteya S. Utility and Feasibility of Removing Surgical Staples from the Remnant Stomach or Gastric Conduit during Endoscopic Submucosal Dissection. Intern Med 2023; 62:963-972. [PMID: 36047114 PMCID: PMC10125828 DOI: 10.2169/internalmedicine.9759-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Endoscopic submucosal dissection (ESD) for gastric cancer in the remnant stomach poses some specific technical difficulties due to severe fibrosis and the presence of surgical staples. Therefore, we clarified the feasibility and safety of removing staples. Methods We retrospectively analyzed ESD outcomes of cases of gastric cancer in the remnant stomach. Materials This study reviewed 227 patients who underwent ESD for gastric cancer in the remnant stomach or gastric conduit. Patients were divided into those in whom resection extended to the anastomotic site or suture line (AS group; n=90) and those without such extension (non-AS group; n=137). The AS group was further divided into cases in which staples were removed (staple group; n=22) and those in which they were not (control group; n=68). Results The rates of specimen damage and curative resection and the duration and speed of the procedure were significantly worse in the AS group than the non-AS group. There were no significant differences between the staple group and the control group in the curative or complete resection rates, and no complications occurred in the staple group. In a propensity score-matched analysis, the rate of specimen damage was significantly lower in the staple group than in the control group (p=0.002), and the procedure speed tended to be faster (p=0.077). Conclusion Staple removal may improve the outcomes of ESD in patients with gastric cancer in the remnant stomach or gastric conduit by reducing the risk of specimen damage and increasing the procedure speed without complications.
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Affiliation(s)
- Yugo Suzuki
- Department of Gastroenterology, Toranomon Hospital, Japan
| | - Kosuke Nomura
- Department of Gastroenterology, Toranomon Hospital, Japan
| | - Akira Matsui
- Department of Gastroenterology, Toranomon Hospital, Japan
| | | | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Japan
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The comparison of clinical results between hand suturing and mechanical stapling for gastrojejunostomy and jejunojejunostomy after SSPPD. Int J Surg 2013; 11:161-3. [PMID: 23295459 DOI: 10.1016/j.ijsu.2012.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 12/07/2012] [Accepted: 12/13/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Mechanical stapling method is widely established alternative to conventional hand suturing. METHOD For gastrointestinal anastomoses. In this study, we compare the clinical results of mechanical stapling with those of hand suturing for gastrojejunostomy and jejunojejunostomy after Subtotal Stomach Preserving Pancreaticojejunostomy (SSPPD). METHODS Between 2002 and 2007, 42 patients who underwent SSPPD with concise records on operative procedure and time required for gastrojejunostomy and jejunojejunostomy were enrolled. Out of 42 patients, the mechanical stapling for gastrojejunostomy and jejunojejunostomy after SSPPD was performed for 19 patients and hand suturing for those in SSPPD was done for 23 patients. RESULTS All clinical characteristics were similar in both groups. There was no statistical difference between both groups in the rate of complications related to gastrojejunostomy and jejunojejunostomy. However, days of nasogastric intubation and days until liquid diet in the stapled group were significantly shorter than those in the hand sutured group. Time required for gastrojejunostomy and jejunojejunostomy was significantly shorter in the stapled group than in the hand sutured group. CONCLUSIONS This study suggested that stapled anastomoses might require a shorter time to perform and decreased time for nasogastric intubation and until liquid diet is introduced.
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Seo SH, Kim KH, Kim MC, Choi HJ, Jung GJ. Comparative Study of Hand-Sutured versus Circular Stapled Anastomosis for Gastrojejunostomy in Laparoscopy Assisted Distal Gastrectomy. J Gastric Cancer 2012; 12:120-5. [PMID: 22792525 PMCID: PMC3392323 DOI: 10.5230/jgc.2012.12.2.120] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 03/12/2012] [Accepted: 03/20/2012] [Indexed: 12/04/2022] Open
Abstract
Purpose Mechanical stapler is regarded as a good alternative to the hand sewing technique, when used in gastric reconstruction. The circular stapling method has been widely applied to gastrectomy (open orlaparoscopic), for gastric cancer. We illustrated and compared the hand-sutured method to the circular stapling method, for Billroth-II, in patients who underwent laparoscopy assisted distal gastrectomy for gastric cancer. Materials and Methods Between April 2009 and May 2011, 60 patients who underwent laparoscopy assisted distal gastrectomy, with Billroth-II, were enrolled. Hand-sutured Billroth-II was performed in 40 patients (manual group) and circular stapler Billroth-II was performed in 20 patients (stapler group). Clinicopathological features and post-operative outcomes were evaluated and compared between the two groups. Results Nosignificant differences were observed in clinicopathologic parameters and post-operative outcomes, except in the operation times. Operation times and anastomosis times were significantly shorter in the stapler group (P=0.004 and P<0.001). Conclusions Compared to the hand-sutured method, the circular stapling method can be applied safely and more efficiently, when performing Billroth-II anastomosis, after laparoscopy assisted distal gastrectomy in patients with gastric cancer.
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Affiliation(s)
- Su Hyun Seo
- Department of Surgery, Dong-A University College of Medicine, Busan, Korea
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Oh SJ, Hong JJ, Oh CA, Kim DH, Bae YS, Choi SH, Choi MG, Noh JH, Sohn TS, Bae JM, Kim S. Stapling technique for performing Billroth II anastomosis after distal gastrectomy. J Gastrointest Surg 2011; 15:1244-6. [PMID: 21170599 DOI: 10.1007/s11605-010-1403-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2010] [Accepted: 11/22/2010] [Indexed: 01/31/2023]
Abstract
The circular stapling technique has been widely applied for gastrointestinal anastomosis in gastrectomies (open or laparoscopic) for distal gastric cancers. We describe this method for use in performing Billroth II anastomosis in distal gastrectomies. From 2002-2009, we report the results following the use of the circular stapling technique performed in 520 patients at a single institution. The median time of completing the anastomosis was shorter using the stapling technique compared to the hand-sewn technique. The use of the stapler resulted in two cases of minor intraluminal bleeding at the anastomotic site. The circular stapling method can be applied safely and more efficiently in performing Billroth II reconstruction after distal gastrectomy compared to the hand-sewn method in patients with gastric cancer.
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Affiliation(s)
- Seung Jong Oh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong Kangnam-Gu, Seoul 135-710, South Korea
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Filipovic N, Cvetkovic A, Isailovic V, Matovic Z, Rosic M, Kojic M. Computer simulation of flow and mixing at the duodenal stump after gastric resection. World J Gastroenterol 2009; 15:1990-8. [PMID: 19399932 PMCID: PMC2675090 DOI: 10.3748/wjg.15.1990] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the flow and mixing at the duodenal stump after gastric resection, a computer simulation was implemented.
METHODS: Using the finite element method, two different Billroth II procedure cases (A and B) were modeled. Case A was defined with a shorter and almost straight duodenal section, while case B has a much longer and curved duodenal section. Velocity, pressure and food concentration distribution were determined and the numerical results were compared with experimental observations.
RESULTS: The pressure distribution obtained by numerical simulation was in the range of the recorded experimental results. Case A had a more favorable pressure distribution in comparison with case B. However, case B had better performance in terms of food transport because of more continual food distribution, as well as better emptying of the duodenal section.
CONCLUSION: This study offers insight into the transport process within the duodenal stump section after surgical intervention, which can be useful for future patient-specific predictions of a surgical outcome.
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Anwar S, Hughes S, Eadie AJ, Scott NA. Anastomotic technique and survival after right hemicolectomy for colorectal cancer. Surgeon 2004; 2:277-80. [PMID: 15570847 DOI: 10.1016/s1479-666x(04)80097-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To compare the long-term outcome of patients after right hemicolectomy for colorectal cancer undergoing ileocolonic reconstruction either by a sutured technique or by side-to-side stapled anastomosis. METHODS Single surgeon series from 1992 to 2001 comprising 100 consecutive patients, 59 with hand sutured reconstruction and 41 undergoing TLC 55mm stapled side-to-side anastomosis. Details of gender, patient age, and elective versus emergency presentation, Dukes stage, and curative versus palliative resection were recorded prospectively. In addition, post-operative hospital stay and subsequent survival were determined by prospective protocol follow-up. RESULTS Overall 24% of the patients studied presented as emergencies and underwent a palliative procedure. There were no anastomotic leaks in either the stapled or sutured groups. Hospital mortality was also not significantly different--stapled reconstruction, 7%, sutured reconstruction, 10% (p value 0.624). Overall long-term cancer outcome was the same for both anastomotic techniques, both stapled and sutured groups having a median survival of 2.9 years. CONCLUSIONS Stapled ileocolonic reconstruction after right hemicolectomy for colonic carcinoma is a safe and reliable surgical technique associated with long-term cancer outcomes comparable with those obtained by the sutured anastomotic technique.
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Affiliation(s)
- S Anwar
- Department of Colorectal Surgery, Hope Hospital, Salford, Manchester, UK.
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Docherty JG, McGregor JR, Akyol AM, Murray GD, Galloway DJ. Comparison of manually constructed and stapled anastomoses in colorectal surgery. West of Scotland and Highland Anastomosis Study Group. Ann Surg 1995; 221:176-84. [PMID: 7857145 PMCID: PMC1234951 DOI: 10.1097/00000658-199502000-00008] [Citation(s) in RCA: 156] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The authors compared both the initial and the long-term outcomes of patients undergoing stapled and sutured colorectal anastomoses. SUMMARY BACKGROUND DATA Sutured and stapled large bowel anastomoses are perceived to be equally safe, but concern has been raised about increased rates of tumor recurrence with the use of stapling instruments. METHODS The outcome of patients with sutured and stapled colorectal anastomoses were compared in a prospective, multicenter, randomized study. Factors affecting long-term outcomes were assessed by both univariate and multivariate analysis. RESULTS Seven hundred thirty-two patients were recruited. There was a significant increase in radiologic leakage in the sutured group (14.4% vs. 5.2%, p < 0.05), but there was no difference in clinical anastomotic leak rates, morbidity, or postoperative mortality. Tumor recurrence and cancer-specific mortality were higher in the sutured patients (7.5% and 6.7%, respectively) and in patients with anastomotic leaks. CONCLUSIONS This study shows that suturing or stapling are equally safe in large bowel surgery. However, it also shows a long-term benefit of stapling in colorectal cancer patients.
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Affiliation(s)
- J G Docherty
- Department of Surgical Gastroenterology, Gartnavel General Hospital, Glasgow, Scotland, United Kingdom
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Atabek U, Pello MJ, Spence RK, Alexander JB, Camishion RC. Arterial vasopressin for control of bleeding from a stapled intestinal anastomosis. Report of two cases. Dis Colon Rectum 1992; 35:1180-2. [PMID: 1473423 DOI: 10.1007/bf02251974] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Postoperative bleeding from a stapled intestinal anastomosis is a rare complication. In previously reported cases, the bleeding either ceased spontaneously or required reoperation for direct control. We report two cases in which the bleeding was controlled using an intra-arterial vasopressin infusion. To our knowledge, this technique has not been previously reported for management of this problem. We had initial concerns about creating ischemia at the anastomosis, which could lead to disruption. Neither patient demonstrated subsequent problems with the anastomosis. Intra-arterial vasopressin infusion appears to be an effective method for controlling bleeding from a stapled intestinal anastomosis and can avert the need for reoperation.
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Affiliation(s)
- U Atabek
- Department of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School at Camden, Cooper Hospital/University Medical Center
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George WD. Suturing or stapling in gastrointestinal surgery: a prospective randomized study. West of Scotland and Highland Anastomosis Study Group. Br J Surg 1991; 78:337-41. [PMID: 2021851 DOI: 10.1002/bjs.1800780322] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A prospective randomized study of 1004 patients is reported, comparing surgical stapling and manual suturing techniques in the construction of gastrointestinal anastomoses. The incidence of clinical leaks was similar between the two groups (sutured 3.2 per cent, stapled 4.7 per cent; P = 0.22), while for radiological leaks the incidence was significantly higher in the sutured group (12.2 per cent versus 4.1 per cent, P less than 0.05). Stapling instruments afforded significantly quicker anastomoses, mean(s.e.m.) 28.1(0.7) versus 14.3(0.5) min (P less than 0.001), and quicker operations, 115.5(2.4) versus 103.8(2.2) min (P less than 0.001). The two groups were found to be comparable in other respects such as operative mortality, requirements for blood transfusion, incidence of infective complications, recovery of gastrointestinal function and postoperative hospital stay.
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Affiliation(s)
- W D George
- University Department of Surgery, Western Infirmary, Glasgow, UK
- Gartnavel General Hospital, Glasgow, UK
- Raigmore Hospital, Inverness, UK
- Crosshouse Hospital, Kilmarnock, UK
- Inverclyde Royal Hospital, Greenock, UK
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Jex RK, van Heerden JA, Wolff BG, Ready RL, Ilstrup DM. Gastrointestinal anastomoses. Factors affecting early complications. Ann Surg 1987; 206:138-41. [PMID: 3496862 PMCID: PMC1493099 DOI: 10.1097/00000658-198708000-00004] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A retrospective review of gastric and colonic anastomoses during a recent 12-month period was performed at the Mayo Clinic. One hundred sixty-nine patients had gastroduodenal or gastrojejunal anastomoses (Group I). Five hundred nineteen patients had ileocolonic or ileorectal (222) and colocolonic or colorectal (297) anastomoses (Group II). Major anastomotic complication rates for Group I patients were: leaks, 1%; hemorrhage, 2%; and stenosis or obstruction, 2%. Reoperations and deaths secondary to anastomotic complications during the postoperative period were 2% and 0.6%, respectively. Corresponding rates for Group II were 2%, 1%, and 4%, with reoperative and anastomotic death rates of 1% and 0.2%, respectively. In Group I patients, length of operation had a significant effect (p less than 0.01) on anastomotic complications. In Group II patients, a significant increase in complications was related to the presence of obstruction (p less than 0.001), recent weight loss (greater than 10 pounds) (p less than 0.02), malignancy (p less than 0.04), and sepsis (p less than 0.05).
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Thiede A, Fuchs KH, Wirtz HJ, Hamelmann H. [Roux-Y reconstruction following distal stomach resection using only staplers]. LANGENBECKS ARCHIV FUR CHIRURGIE 1986; 367:119-27. [PMID: 3959680 DOI: 10.1007/bf01259261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The spreading of stapled suture techniques has also entailed the utilization of staplers in gastric surgery. A functional, up-to-date, and exclusively stapled reconstruction procedure, Roux-Y-reconstruction, after subtotal gastrectomy was established and analyzed in a pilot study (n = 25). In doing so, one proceeded as follows after subtotal gastrectomy and systematic lymphadenectomy in cases of carcinoma: duodenal closure (GIA or TA30), gastric resection (TA90), jejunojejunostomy (EEA25), gastrojejunostomy (EEA25/28), closure of the projecting efferent loop (GIA). This study intended to achieve the following advantages: increased suture safety, saving of time, reduction of complications, and especially the extension of indications regarding age and localization of the tumor. A special program to eliminate mistakes in handling is required for the sole and systematic application of staplers in the upper gastrointestinal tract. Every complication occurring during and after surgery was carefully recorded in this study and the attainable quality of life after subtotal gastrectomy was assessed.
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Didolkar MS, Reed WP, Elias EG, Schnaper LA, Brown SD, Chaudhary SM. A prospective randomized study of sutured versus stapled bowel anastomoses in patients with cancer. Cancer 1986; 57:456-60. [PMID: 3510704 DOI: 10.1002/1097-0142(19860201)57:3<456::aid-cncr2820570309>3.0.co;2-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Eighty-eight cancer patients with the presence of one or more adverse factors for healing (carcinomatosis, adhesions, prior chemotherapy and radiation therapy, bowel obstruction, anemia, and low leukocyte count or albumin value) were prospectively randomized to undergo conventional two-layer hand suturing (45 patients) or mechanical stapling with a GIA/TA instrument (U.S. Surgical Corp., Norwalk, CT) (43 patients) of the large or small bowel anastomosis. Age, sex, complete blood count findings, and all biochemical plasma values were comparable in both groups. The anastomosis took an average of 19 minutes for the sutured and 9 minutes for the stapled technique (P = 0.0001), but the average length of operation, postoperative return of bowel function, and hospital stay were comparable in both groups. Bowel fistula was seen in one case of stapled anastomosis (P = not significant). The pulmonary and wound complication rates were the same in both groups. Of the four deaths (4.5%) due to causes unrelated to bowel anastomosis, three occurred in the stapled and one in the sutured group. It was concluded that a stapled anastomosis is as safe as a sutured one in patients with advanced-stage cancer. It saves time in anastomosis, but does not save time in postoperative return of the bowel function and hospital stay.
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Late disruption of stapled oesophagojejunal anastomosis. Br J Surg 1983; 70:448. [PMID: 6871633 DOI: 10.1002/bjs.1800700726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Nahtapparate in der Chirurgie. Eur Surg 1982. [DOI: 10.1007/bf02601866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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