Explore the value of ERCP in patients with choledocholithiasis after Billroth Ⅱ gastrointestinal anastomosis / 国际外科学杂志

Objective To explore the value of endoscopic retrograde cholangiopancreatography (ERCP) in patients with choledocholithiasis after Billroth Ⅱ gastrointestinal anastomosis.Methods A retrospective cohort study was conducted to retrospective review the data of 189 patients with choledocholithiasis treated by ERCP from December 2015 to November 2017 in Department of Hepatobiliary Surgery,Second Hospital of Hebei Medical University.According to the history of Billroth Ⅱ gastrointestinal anastomosis,the patients who have not undergone digestive surgery were divided into the normal group(n =167) and patients who have undergone digestive surgery were divided into reconstruction group (n =22).The operation time,the success rate of stone extraction,complications,the hospitalization time,total hospitalization expenses were compared between the two groups.Measurement data with normal distribution were represented as (Mean ± SD) and comparison between groups was analyzed using the t test.Measurement data with skewed distribution were described as M (range).Comparisons of count data were analyzed using the x2 test or Fisher exact probability.Results The operation time of the normal group was (40.18 ± 11.80) min,and the success rate of ERCP was 97.60％ (163/167),the operation time of reconstruction group was(61.81 ± 13.21) min,and the success rate of ERCP was 81.82％ (18/22),There were significant differences between the two groups (t =0.105,x2 =10.400,P ＜ 0.05).The complications,the hospitalization time and the total hospitalization expense of the normal group were 16.17％ (27/167),(3.47 ± 1.55) d,(20 620.69 ± 3 117.88) yuan,the reconstruction group were 18.18％ (4/22),(4.18 ± 2.08) d,(22 426.41 ±5 916.30) yuan,with no statistically significant difference (x2 =0.000,t =4.204),t =10.828,P ＞ 0.05).Conclusions ERCP is safe and feasible for patients with choledocholithiasis after Billroth Ⅱ gastrointestinal anastomosis.It also has a high success rate of stone removal and small trauma,which is worthy of promotion.

Effects of blood transfusion on gastrointestinal anastomosis – Our experience in 52 patients.

Background: Patients, operative technique and instrumental factors, all affect the intestinal anastomosis outcome. Preoperative, intraoperative and postoperative blood transfusion influences the very common surgical procedure. Blood transfusion is discriminated from other risk factors in that; its intentionally added risk factor. Aims & Objective: The effect of intra-operative and post-operative blood transfusion on elective gastrointestinal anastomosis mainly evaluated by following factors; (1) surgical site complications (2) anastomosis leak (3) faecal fistula and (4) death. Material and Methods: To evaluate the effect of blood transfusion (Intraoperative and Postoperative) in outcome of Gastrointestinal anastomosis at Government General Hospital. Data collected from fifty two patients who underwent elective gastro intestinal anastomosis at our hospital. Results: The total number of patients was 52, 28male and 24 female. Mean age was 43 years, 17.3% were underwent small bowel anastomosis, 83.7% were underwent large bowel anastomosis, and 15.38% were transfused intraoperative and 26.92% were transfused postoperatively. Regardless other risk factors the incidence of surgical site infection was significantly high in transfused patients (25%), also there was a high rate of other complications in transfused patients. Conclusion: Intraoperative and post-operative blood transfusion is a good predictor for development of complications in elective intestinal anastomosis. There were some limitations in this study, as other risk factors might change the outcome and the effect of blood amount wasn’t considered, so more precise studies have to be done to give more support to our results.

Application of nickel titanium compression anastomosis clip in gastrointestinal anastomosis / 中华消化外科杂志

Objective To investigate the efficacy and safety of nickel titanium compression anastomosis clip (CAC) in gastrointestinal anastomosis.Methods The clinical data of 413 patients who received gastrointestinal anastomosis with nickel titanium CAC or curved stapler at the First Affiliated Hospital of Fujian Medical University from January 2007 to December 2011 were retrospectively analyzed.All the patients were divided into the CAC group (227 patients) and the curved stapler group (186 patients).The time for gastrointestinal anastomosis,anastomotic bleeding,complications,condition of the incision sites,the first postoperative flatus and time for the excretion of the CAC between the 2 groups were compared.All data were analyzed using the t test or chisquare test.Results The time for gastrointestinal anastomosis of the CAC group was (8.3 ± 2.5) minutes,which was significantly shorter than (18.7 ± 3.6) minutes of the curved stapler group (t =5.74,P ＜ 0.05).There were no significant difference in the time of postoperative flatus,duration of hospital stay and costs between the 2 groups (t =0.27,1.32,3.11,P ＞ 0.05).No patients in the CAC group had anastomotic bleeding,while the incidence of anastomotic bleeding of the curved stapler group was 3.23 ％ (6/186),with a significant difference between the 2 groups (x2=7.43,P ＜ 0.05).The incidences of gastric emptying dysfunction of the CAC group and the curved stapler group were 0.88％ (2/227) and 1.08％ (2/186),with no significant difference between the 2 groups (x2=0.04,P ＞ 0.05).The incidences of postoperative anastomotic stricture and anastomositis were 0 (0/227) and 11.01％ (25/227) in the CAC group,and 2.15％ (4/186) and 21.50％ (40/186) in the curved stapler group,with significant differences between the 2 groups (x2 =4.93,8.49,P ＜ 0.05).No anastomotic fistula was detected in the 2 groups.The CAC was excreted at postoperative day 12-26.Conclusion CAC is safe and effective for gastrointestinal anastomosis.

Ventajas del inicio precoz de dieta enteral en anastomosis gastrointestinales: experiencia preliminar / Advantages of early enteral feeding in gastrointestinal anastomosis: initial experience

Demostrar el beneficio del inicio enteral posterior a anastomosis gastrointestinales, comparado con el manejo tradicional. Estudio realizado en el Hospital General del Sur “Dr. Pedro Iturbe”, Maracaibo. Se realizó un estudio prospectivo, descriptivo y transversal, basado en el análisis de los pacientes sometidos a anastomosis gastrointestinales durante el período comprendido entre septiembre 2008 y marzo 2009, con diagnóstico de trauma abdominal penetrante, neoplasias, restitución del tránsito intestinal y obstrucción intestinal. Se evaluaron las variables edad, sexo antecedentes, diagnóstico de ingreso, tipo de intervención quirúrgica, anastomosis realizada, tiempo de estancia hospitalaria, aparición de íleo postoperatorio, tolerancia a la dieta (náuseas y/o vómitos), dehiscencia de anastomosis, complicaciones infecciosas y mortalidad. Se evaluó un total de 51 pacientes; 27 casos y 24 controles, edad promedio de 42,7±21 años y 33,3±10,5 años respectivamente. La mayoría presentó antecedentes de importancia: quirúrgicos 29,4% respiratorios 13,7%, cardiovasculares 9,8%. El diagnóstico de ingreso más frecuente fue herida por arma de fuego en 41,2% pacientes, herida por arma de blanca, restitución de transito neoplasias 15,7% cada uno. Complicaciones postoperatorias 16,7% de los controles presentó íleo postoperatorio mientras ninguno de los casos presentó esta complicación. Sólo 7,4% de los casos presentó dehiscencia total o parcial de la anastomosis realizada, comparado con 16,7% de dehiscencias en el grupo control. Complicaciones infecciosas abscesos intraabdominales en los casos 3,7%, en contraste con los controles 50%, infecciones de herida 25% casos, mientras el segundo 18,5%, entre otras. El tiempo de estancia hospitalaria fue de 4,7±1,8 días (3-10) para el grupo de los casos, en oposición a 10,2±6,3 días (5-24) en el grupo control. No hubo muertes en los pacientes estudiados. El inicio de dieta enteral precoz, es beneficioso para todo paciente...

To demostrate the benefit of early enteral feeding in patients with gastrointestinal anastomosis, comparing with traditional management. Study done in Hospital General de Sur “Dr. Pedro Iturbe”, Maracaibo. This is a prospective, descriptive and transversal in patients submitted to gastrointestinal anastomosis in the period between September 2008 and March 2009 with diagnosis of penetrating abdominal trauma, cancer, restoration of intestinal continuity and intestinal obstruction. There were evaluated age, gender, initial diagnosis, surgical procedure, hospital stay, postoperative ileus, complications and mortality. There were evaluated 51 patients, 27 cases and 24 control. Mean age 42,7±21 years and 33,3±10,5, years respectively. Diagnosis were gunshort wounds 41,2%, stab wounds, restoration of intestinal continuity and cancer 15,7% each. In control group there was a 16,7% of postoperative ileus and none in case group. There was a 7,4% of anastomotic leak-age in case group vs 16,7% in control group. Intraabdominal abscess was 3,7% in case group vs 50% in control group. Hospital stay 4,7±1,8 days in case group and 10,2±6,3 days in control group. No mortality in this study. Early enteral feeding has benefit in all patients submitted to gastrointestinal anastomosis, reduces complications, hospital stay and mortality. The gastrointestinal phisiology is not altered and improves cicatrization.

The Safety and Usefulness of Synthetic Absorbable Monofilament, Glycoside-epsilon-caprolactone- trimethylene Carbonate Interpolymer, in Gastrointestinal Anastomosis and Closure

PURPOSE: Synthetic absorbable monofilaments offer excellent glide characteristics and cause minimal tissue trauma as a result of their smooth monofilament structure and gradual absorption within the healing tissues. For these reasons, these suture materials are commonly used in various surgical fields such as gastroenterology, urology, gynecology, and plastic surgery. The aim of this study was to evaluate the safety and usefulness of a new synthetic absorbable monofilament, Glycoside-epsilon-caprolactone-trimethylene carbonate interpolymer (GCT), in gastrointestinal anastomosis and closure. MATERIALS AND METHODS: We evaluated 55 gastrointestinal anastomoses and closures using GCT (MONOSYNR, B. Braun, Germany) in 47 patients who underwent gastric surgery between December 2001 and May 2002 at Seoul National University Hospital. Patient's characteristics, operative procedure, surgeon's opinion of handling properties of GCT, and suture-related complications were analyzed. RESULTS: There were 34 males and 13 females (M:F= 2.6:1) with an average age of 54.2 years old. Forty-five cases of gastrointestinal anastomosis (20 gastrojejunostomies and 25 jejunojejunostomies) and 10 cases of intestinal closure (7 gastrostomy closures and 3 duodenal stump closures) were performed in 41 cases of stomach cancer, three of peptic ulcer disease, two of GIST, and one MALToma. The handling properties of GCT according to the criteria of knot breaking load, knot security, and placing property were always scored with 7 to 9 points (10=excellent, 1=very poor). Two cases of postoperative complications (3.6%) were noted. One was a leak of the gastrojejunostomy site which was successfully managed conservatively, and the other was a stricture of the gastrojejunostomy site which was managed by reoperation (side-to-side jejunojejunostomy). CONCLUSION: GCT seems to be an applicable suture material for various gastrointestinal anastomoses and closures.

Technical Improvement of the Gastrointestinal Anastomosis After Gastrectomy / 中国医师杂志

Objective To summarize the experience of using anastomotic apparatus and ring in the reconstruction of alimentary tract after gastrectomy. Methods Anastomotic apparatus or anastomotic ring was used to reconstruct alimentary tract after total or partial gastrectomy including esophagojejunostomy, esophagogastrostomy, gastroduodenostomy, gastrojejunostomy and jejunojejunostomy. Results The reconstruction of alimentary tract after gastrectomy using anastomotic apparatus and ring was successfully completed once in 182 cases. There were not anastomotic leakage, bleeding and infection after operation. During the follow-up period of 3～12 months, gastroscope or barium meal examinations showed that only 3 cases had the stricture of anastomotic entrance, and the other patients recovered well. Conclusion Compared with using traditional manual anastomosis to reconstruct alimentary tract after gastrectomy, anastomotic apparatus and ring had the advantages of convenience, simplicity, rapidity and reliability, and could raise operative efficiency greatly, shorten operative time and prevent the complications of post-operation such as the leakage and striture of anastomotic entrance. Using anastomotic apparatus and ring was recommended in the reconstruction of alimentary tract.