Intracorporeal esophagojejunostomy using hemi-double-stapling technique after laparoscopic total gastrectomy in gastric cancer patients

PURPOSE: To present the feasibility and safety of Roux-en-Y esophagojejunostomy using hemi-double-stapling technique after laparoscopic total gastrectomy. METHODS: We reviewed the outcomes from 58 consecutive patients with gastric cancer who underwent laparoscopic total gastrectomy. The clinicopathological characteristics including postoperative complications were examined. RESULTS: The mean age and body mass index were 57.3 ± 9.7 years and 23.7 ± 2.6 kg/m², respectively. The mean overall total operation was 199.8 ± 57.0 minutes. Intraoperative blood loss was 81.6 ± 56.3 mL and there was no open conversion. The patients' hospital stay was a mean 9.6 ± 2 days. The mean proximal margin of the specimens was 2.7 ± 1.8 cm. There were 3 cases (5.1%) of anastomosis leakage, but all were controlled successfully by endoscopic stent. CONCLUSION: The circular HDST technique is simple and reliable without any significant demerits with respect to safety concerns or difficulty of operation.

Value of double stapling technique with curved cutter stapler in low colorectal anastomosis / 上海第二医科大学学报

Objective To evaluate the value of double stapling technique with curved cutter stapler in colorectal anastomosis,especially in low colorectal anastomosis. Methods The clinical data of 168 cases of rectal carcinomas treated with double stapling technique with curved cutter stapler were retrospectively reviewed.The intraoperative condition,postoperative complications and findings during follow up were analysed. Results During the operations,the processes of closure and anastomosis of all the patients were satisfactory,and no operative death occurred.After the operations,4 cases(2.4%) had anastomotic leakage,3 cases(1.8%) had anastomotic bleeding,and 2 cases(1.2%) had rectovaginal fistula.All the complications were cured.There was no anastomotic stricture. Conclusion Double stapling technique with curved cutter stapler may help to accomplish low colorectal anastomosis which is a difficult task for handed suture.

The double stapling technique for anus-saving in rectal cancer / 临床外科杂志

Objective To evaluate role of double stapling technique in anus-saving operations for patient with low rectal carcinoma.Method The double stapling technique was used for anus-saving in colorectal anastomosis after anterior resection in 52 patiens with rectal cancer from 1994 to 1999,and the results were evaluated.Results 2 cases were failed to close rectal.4 cases were failed to anastomose.2 cases had anastomotic fistula(3.8%).3 cases had anastomotic stenosis (5.8%).2 cases had waund infection.1 case had anastomotic bleeding.There was no operative death.Conclusion The double stapling technigue provided a safe alternative for anus-saving operation in patients with rectal cancer.

Application of double stapling technique in low anterior resection of the rectal carcinoma / 临床外科杂志

Objective To evaluate the role of double stapling technique in low rectal anastomosis that can save anus.Methods 114 patients with low rectal cancer from June 1994 to January 2002 were treated by low anterior resection of the rectal carcinoma in which the double stapling technique was used,were valuated and the experience was presented.Results Operations of all the 114 patients were successful. Complication included anastomotic fistula in 4 patients (3.5%)and anastomotic stenosis in 5 patients (4.4%) and they were healed by irrigating ?draining the wound and enlarging anus respectively.Conclusion The low anterior resection of the low rectal carcinoma which can save anus becomes safe and time-saving .

Double Stapling Technique in the Management of Low Rectal Carcinoma / 中国微创外科杂志

12 months in 36 patients),during the follow-up 2 patients died.Conclusions The DST is minimally invasive for the treatment of low rectal carcinoma with high rate of anus conservation,and can improve the life quality of the patients.

Low Anterior Resection for Rectal Cancer Using Double Stapling Technique

PURPOSE: Since its introduction by Knight and Griffen in 1980, the double stapling technique has gained widespread popularity in performing the low anterior resection for the rectal cancer. But their effectiveness is not clear. The purpose of this study is to evaluate the usefulness of the low anterior resection using the double stapling technique for rectal cancer in an oncological, technical standpoints. METHODS: Perioperative and follow up data were retrospectively reviewed in all patients undergoing the low anterior resection using the double stapling technique by same surgeons for rectal cancer over a 2.5 year period. RESULTS: Thirty two rectal cancer patients had double stapling technique anastomoses. There was no postoperative mortality. Intraoperative complications including rectal wall tearing, incomplete doughnuts, misfiring and extraction related problems occurred in 9 of 32 patients (28.2%). Early and late postoperative complications occurred in 9 (28.8%) and 8 (24.9%) of 32 patients. Early anastomotic leak developed in 1 patient (3.1%) and anastomotic site bleeding developed in 2 patient (6.3%). Lately, the local recurrence occurred in 3 patients (9.3%) and anastomotic site stricture occurred in 3 patients (9.3%). CONCLUSIONS: The low anterior resection using the double stapling technique has relatively low rate of leakage, stricture, local recurrence. The double stapling technique can be performed for mid or low rectal cancer with greater safety and facility.

Clinical Review of the Double Stapling Technique for Lower Rectal Cancer

From January 1993 to December 1995, 47 patients with rectal carcinomas underwent a rectal anastomosis using the double stapling technique at the Surgical Department of Kwang-ju Christian Hospital. The major advantages of the double stapling technique for lower rectal cancer over the single stapling technique or a hand-sewn operation are as follows:1) Insertion of a purse-string suture is eliminated, and application of a linear stapler to close the distal rectum may be performed with greater ease. 2) In addition, fecal contamination and spillage of tumor cells from the rectal segment are minimized. 3) Differences in the sizes of the colons and rectums are not a concern in constructing the anastomosis. 4) The operating time is shorter. The following results were obtained by a comparison with 24 patients with rectal carcinoma who had undergone a rectal anastomosis using the double stapling technique from January 1989 to December 1992 which was reported in a previous study:1) Anastomotic stenosis was decreased from 8.3% to 4.2% because of reduced ischemia due to the double row of staples and the reduced injury due to compression of tissue between the anvil and the cartridge with experience. In addition, it resulted from reduced tension of the anastomosis due to sufficients mobilization of the proximal colon and from selection of large cartridge (33 mm). 2) Anastomotic leakage, even though the same location as the tumor and in the advanced age group, was decreased from 4.2% to 0% because the blood circulation was maintained and unnecessary tension was reduced with experience. In addition, it resulted from reinforced suture of the anastomotic site which was performed after anastomosis. 3) Systemic recurrence was the same result as that of the previous study(4.2/4.3%). 4) Local recurrence, even though at the same distal distance from the margin of the cancer, was increased from 0% to 2.1% because of advancing the pathologic stage (B2, C1>B1, B2) and increasing the poorly differentiated pathologic type.

Clinical Review of the Double Stapling Technique for Lower Rectal Cancer

From January 1993 to December 1995, 47 patients with rectal carcinomas underwent a rectal anastomosis using the double stapling technique at the Surgical Department of Kwang-ju Christian Hospital. The major advantages of the double stapling technique for lower rectal cancer over the single stapling technique or a hand-sewn operation are as follows:1) Insertion of a purse-string suture is eliminated, and application of a linear stapler to close the distal rectum may be performed with greater ease. 2) In addition, fecal contamination and spillage of tumor cells from the rectal segment are minimized. 3) Differences in the sizes of the colons and rectums are not a concern in constructing the anastomosis. 4) The operating time is shorter. The following results were obtained by a comparison with 24 patients with rectal carcinoma who had undergone a rectal anastomosis using the double stapling technique from January 1989 to December 1992 which was reported in a previous study:1) Anastomotic stenosis was decreased from 8.3% to 4.2% because of reduced ischemia due to the double row of staples and the reduced injury due to compression of tissue between the anvil and the cartridge with experience. In addition, it resulted from reduced tension of the anastomosis due to sufficients mobilization of the proximal colon and from selection of large cartridge (33 mm). 2) Anastomotic leakage, even though the same location as the tumor and in the advanced age group, was decreased from 4.2% to 0% because the blood circulation was maintained and unnecessary tension was reduced with experience. In addition, it resulted from reinforced suture of the anastomotic site which was performed after anastomosis. 3) Systemic recurrence was the same result as that of the previous study(4.2/4.3%). 4) Local recurrence, even though at the same distal distance from the margin of the cancer, was increased from 0% to 2.1% because of advancing the pathologic stage (B2, C1>B1, B2) and increasing the poorly differentiated pathologic type.

Clinical application of double stapling technique in anus-preserving operation of low and middle rectal cancer / 中国现代普通外科进展

Objective:To study the clinical application and postoperative complication of double stapling technique (DST) in anus-preserving operation of low and middle rectal cancer. Method:From April 2002 to April 2006, clinical data of 75 cases with low and middle rectal cancer were analyzed retrospectively. Of those 32 cases used DST underwent sphincter-reserving operation(SPO),regard as study group;and 43 cases used SST received SPO, as control group. Clinical pathologic parameters、 postoperative complication and tumor recurrence were compared between the two groups. Results:Operation of all the 75 patients was successful without operative mortality. In DST group patients, defecation function was different from SST group after postoperative 3 and 6 months (P

Gastrojejnostomy with Stapling Technique in Billroth II Gastrectomy

Various methods of gastrojejunostomy can be used in Billroth II gastrectomy. Two-layer sutures as Albert-Lembert type provide more secure anastomosis and one-layer sutures as Gambee type show better mucosal apposition. To take advantage of merits from the two suture types, we adopted stapling technique in gastrojejunostomy. We have performed 131 cases of stapling gastrojejunostomy and the results were compared with those of 313 conventional manual anastomoses. Stapling gastrojejunostomy consists of partial gastric resection, insertion of GIA stapler forks into jejunal and gastric openings at greater curvatures side, firing, closure of the stapler insertion site and placing reinforcing sutures to the apex of the anastomosis. This method shortened the operation time and did not worsen the postoperative recovery course. Gastrojejunostomy complications requiring laparotomy were occurred in 5 cases(3.8%) in stapling group. Complication cases showed adhesive ileus with efferent loop obstructions, which were resolved by bypass and adhesiolysis. In manual group, 5 cases(1.6%) were undertaken exploration due to adhesive bowel obstructions and anastomosis site bleeding. We concluded that stapling gastrojejunostomy is a safe and faster technique which can replace conventional manual anastomosis.

Double stapling technique in anus-saving operation for lower rectal cancer / 中国普通外科杂志

Objective To determine the role of double stapling technique(DST) in anus-saving operations for lower rectal cancer. Methods The clinical data of 96 patients with lower rectal carcinoma treated by DST were analyzed retrospectively. Results There were 63 males and 33 females,aged from 22 to 84 (an average of 57.7 yesars). The distance from the lower end to dens line was 4～7cm.Dukes classfication: 24 patients belonged to A class, 30 B class, 30 C class,and 12 D class. Histological type: 47patients had high differentiation adenocarcinoma, 27 median differentiation adenocarcinoma, 17 low differentiation adenocarcinoma,and 5 mucous adenocarcinoma. No one died after the operation but 12 had anastomotic leakage(12.5%)postoperatively and all healed after treatment; 5 patients had anastomotic constriction(5.2%)postoperatively and all healed with expanding anus. Conclusions DST is a safe alternation for anus-saving operation for patients with rectal cancer.Conservative therapy is effective in the treatment of anastomotic constriction and anastomotic leakage.