Feasibility of totally laparoscopic pylorus-preserving gastrectomy with intracorporeal gastro-gastrostomy for early gastric cancer: a retrospective cohort study

Background

Pylorus-preserving gastrectomy (PPG) has been accepted as a function-preserving surgery for the treatment of early gastric cancer in East Asian countries. Therefore, this study aimed to evaluate the feasibility and safety of totally laparoscopic PPG (TLPPG) with intracorporeal anastomosis.

Methods

A total of 43 patients with early gastric cancer underwent laparoscopy-assisted PPG (LAPPG) with extracorporeal anastomosis between May 2006 and November 2012. The operative outcomes of 22 patients who underwent TLPPG between November 2012 and February 2019 were evaluated, and data were compared with that of the LAPPG group.

Results

No significant difference in the operative time was observed between the two groups. Blood loss was lower in the TLPPG group (18.5 mL) than in the LAPPG group (30.7 mL, p = 0.008), and the length of abdominal incision was shorter in the TLPPG group (3.8 cm) than in the LAPPG group (4.7 cm, p < 0.001). No significant difference in the complication rate was observed between the two groups (13.6% in the TLPPG vs. 9.3% in the LAPPG group, p = 0.594). No anastomosis-related complications occurred in either group. No significant between-group difference was observed in the delayed gastric emptying (TLPPG, 9.1 vs. LAPPG, 7%, p = 0.762). The initiation of postoperative fluid (TLPPG, 1.0 day vs. LAPPG, 3.0 days, p < 0.001) and meal (TLPPG, 3.0 days vs. LAPPG, 4.0 days, p < 0.001) intake was earlier in the TLPPG group than in the LAPPG group. No significant between-group difference was observed in the postoperative hospital stay.

Conclusions

The findings of this study suggest that TLPPG with intracorporeal reconstruction not only is as feasible and safe as LAPPG for the treatment of patients with early gastric cancer but also provides certain advantages such as reduced blood loss and wound size.

Eroded adjustable gastric band migration causing gastric obstruction and perforation in a pregnant lady

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Laparoscopic adjustable gastric banding (LAGB) was considered as one of the most effective management for morbid obesity, with outstanding long-term results on weight loss, comorbidities, and quality of life.

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Reported complications of LAGB include erosion, infection, migration, obstruction, and rarely ischemia.

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We report a case of pregnant woman who underwent LAGB 12 years ago diagnosed as gastric obstruction and perforation that was managed by central gastrectomy with gastro-gastrostomy.

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We encourage the bariatric surgeons to be attentive LAGB complications among women planning for pregnancy.

Background

The laparoscopic adjustable gastric band is the least invasive bariatric surgery, which has the advantage of preserving the anatomy of the gastrointestinal tract. In the last two decades, the laparoscopic adjustable gastric band (LAGB) has largely been replaced by other surgical techniques for weight loss because of its high inseparable complications. Although a popular surgical technique at the time of its introduction in 1993, LAGB nowadays reports for not more than 5.5% of all bariatric procedures. The estimated overall long term complication rates of LAGB are ranging from 0.1% to 28%.

Objective

In this report, we review one of the cases that are considered as an anecdotic event that might follow one of the bariatric procedures.

Methods

We reported a pregnant lady who undergoes gastric banding 12 years ago. presented with progressively increasing colicky epigastric pain, nausea, and vomiting. The investigations show gastric obstruction and perforation secondary to eroded gastric band and migration.

Results

The management was completed by the elimination of the gastric band proceed with central gastrectomy plus gastro-gastrostomy with an excellent outcome for the patient and her baby.

Conclusion

This case highlights an absolutely rare serial complication, that may happen even when the patient presents with a vague complaint. Intraoperative findings can determine the way of management to achieve suitable results. Lastly; we encourage the young Women who underwent or planning for bariatric surgery to do a careful follow-up.