Intrathoracic anastomosis using handsewn purse-string suturing by the double-ligation method in laparo-thoracoscopic esophagectomy

Purpose@#In minimally invasive esophagectomy (MIE), it is important to reduce the rate of anastomotic leakage to ensure its safety. At our institute, the double-ligation method (DLM) has been introduced to insert and fix the anvil of the circular stapler for intracorporeal circular esophagojejunostomy in gastric surgery. We adopted this method for intrathoracic anastomosis (IA) in MIE. The aim of this study was to investigate the safety of IA with DLM in MIE. @*Methods@#In this study, 48 patients diagnosed with primary middle or lower third segment thoracic esophageal carcinoma with clinical stage I, II, III or IV disease were retrospectively evaluated. Postoperative outcomes were assessed. @*Results@#Among the 48 patients, 42 patients underwent laparo-thoracoscopic esophagectomy and IA using a circular stapler with the DLM. The average total operation time and thoracoscopic operation time were 433 and 229 minutes, respectively. The average pursestring suturing time was 4.7 minutes. The rates of anastomotic leakage and stenosis were 2.4% and 14.3%, respectively. The overall incidence of postoperative complications (ClavienDindo grade of ≥III) was 16.7%. The average postoperative stay was 16 days. @*Conclusion@#The procedure of IA using a circular stapler with the DLM in MIE was safe and provided a low rate of anastomotic leakage.

How do Health Care Professionals Change the Recognition of Relationships and Problems Among Them Through Dialogue? Qualitative Descriptive Research Exploring the Process of Home Health Care Promotion in Areas Where Medical Resources are Insufficient Using the Theoretical Framework of Complexity / 日本プライマリ・ケア連合学会誌

Introduction: The Japanese government implemented a community-based integrated care system that provides community healthcare resources for elderly people focusing on home health care in particular. To achieve this, interprofessional teams in the community need to function seamlessly. Thus, we explored the process by which healthcare professionals change their recognition of the relationships and problems among them through the dialogue of home health care promotion.Methods: We held the World Cafe to discuss with healthcare professionals about home health care in a city in Ibaraki Prefecture. All dialogues were audio-recorded, transcribed verbatim, and analyzed using thematic analysis.Results: Although healthcare professionals had strongly recognized the hierarchical relationship, they deepened their mutual understanding by sharing their background and values. While sharing the hope to make equitable relationships, they changed their recognition as follows: home health care was not "someone else's problem" but "their own problem" and "their own community's problem".Conclusion: It is necessary for healthcare professionals to share issues and explore methods to solve them in the community, and to change the relationships among stakeholders because problems related to home health care promotion are complex. This study clarified that healthcare professionals are motivated to seek solutions to problems proactively via their relationships in interprofessional teams in the community.