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Objective:To evaluate the safety and feasibility of double endoscopic bypass, namely endoscopic ultrasound-guided gastroenterostomy (EUS-GE) combined with endoscopic ultrasound-guided biliary drainage (EUS-BD), for malignant gastric outlet and biliary obstruction.Methods:A retrospective analysis was conducted on data of 10 patients with malignant gastric outlet and biliary obstruction who were not suitable for surgery or endoscopic retrograde cholangiopancreatography (ERCP) and treated by double endoscopic bypass in Nanjing Drum Tower Hospital from August 2017 to October 2020. The completion of therapy, clinical efficacy and post-procedure adverse events were analyzed.Results:Ten patients with different malignant cancer successfully underwent EUS-GE and EUS-BD, with procedure time of 60.5±22.3 min (30-100 min). There were no postoperative adverse events. EUS-GE was clinically successful in all 10 cases. Of the 10 EUS-BD cases, 9 were clinically successful, and 1 did not meet the criteria of clinical success. The median follow-up was 71 (37-120) days. None of the 10 patients had recurrent gastric outflow tract obstruction or biliary tract obstruction.Conclusion:Double endoscopic bypass is feasible and effective for patients with malignant gastric outlet and biliary obstruction and without surgery or ERCP opportunity.
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SUMMARY INTRODUCTION: EUS-guided gastroenterostomy (EUS-GE) is a novel procedure for palliation of malignant gastric outlet obstruction (GOO). Our aim was to evaluate the outcomes of this technique in our initial experience. METHODS: Patients with GOO from our institute were included. Technical success was defined as the successful creation of a gastroenterostomy. Clinical success was defined as the ability to tolerate a soft diet after the procedure. We assessed adverse events and diet tolerance 1 month after the procedure. RESULTS: Three patients were included. Technical and clinical success was achieved in all cases. There were no adverse events and good diet tolerance was observed 1 month after the procedure in the included patients. CONCLUSION: EUS-GE is a promising treatment for patients with GOO.
RESUMO INTRODUÇÃO: A gastroenterostomia ecoguiada é um novo procedimento para paliação da obstrução maligna gastroduodenal. Nosso objetivo foi avaliar os resultados dessa técnica em nossa experiência inicial. MÉTODOS: Foram incluídos pacientes com obstrução maligna gastroduodenal de nossa instituição. O sucesso técnico foi definido como a realização adequada de uma gastroenterostomia. O sucesso clínico foi definido como boa aceitação de dieta pastosa durante a internação. Os eventos adversos e a aceitação alimentar foram avaliados um mês após o procedimento. RESULTADOS: Três pacientes foram incluídos. Os sucessos técnico e clínico foram alcançados em todos os casos. Não houve eventos adversos e a aceitação alimentar permaneceu adequada um mês após o procedimento nos pacientes incluídos. CONCLUSÃO: O EUS-GE é um tratamento promissor para pacientes com obstrução maligna gastroduodenal.
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Humans , Gastroenterostomy , Endosonography , Brazil , Stents , Gastric Outlet Obstruction/surgery , Gastric Outlet Obstruction/etiology , Gastric Outlet Obstruction/diagnostic imaging , Tertiary Care CentersABSTRACT
Endoscopic retrograde cholangiopancreatography (ERCP) is an important technique for the diagnosis and treatment of biliary and pancreatic disorders. ERCP in the patients with surgically altered anatomy (SAA) is more technically demanding with high risks of procedural failure and complications, and it is challenging for the endoscopists. Recently, the development of endoscopic devices and the improvement of operator skills have led to SAA-ERCP progresses. The success rate of ERCP and the incidence of complications are similar to those of the patients with normal anatomy. This paper reviews the recent advances on SAA-ERCP, including the effectiveness and safety, and endoscopy and assisted techniques, and summarizes the clinical features of SAA-ERCP.
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Objective@#To study and evaluate the clinical effect of emergency primary resection and anastomosis in the treatment of obstructive left hemicolon carcinoma and the value of preventing reoperation.@*Methods@#From February 1st 2013 to February 1st 2018, a total of 46 patients with obstructive left hemicolon cancer underwent surgical treatment were selected in the First People's Hospital of Jinzhong.According to the random digital table method, 46 patients with obstructive left colon cancer were randomly divided into two groups, with 23 patients in each group.The control group received stage colon resection and anastomosis, and the observation group received stage I resection and anastomosis.The operative condition, postoperative recovery, anastomotic leakage, therapeutic effect of intestinal obstruction, serum inflammatory cytokines and reoperation rate were compared between the two groups.@*Results@#There were no statistically significant differences in the number of lymph nodes dissection, the amount of blood lost during operation and time of operation (all P>0.05). The recovery time of anal exhaust[(2.34 ±0.86)d], the removal time of drainage tube[(4.36±1.52)d], the active time of getting out of bed [(3.81±1.17)d], the hospitalization time[(12.05 ±2.73)d] in the observation group were significantly shorter than those in the control group[(3.29±1.05)d, (6.17±1.84)d, (5.24±1.43)d, (15.76±3.69)d](t=3.357, 3.637, 3.712, 3.876, all P<0.05). The incidence rate of anastomotic fistula in the observation group was not significantly higher than that in the control group (P>0.05), and there was no statistically significant difference in the total effective rate of intestinal obstruction treatment between the two groups (P>0.05). The levels of serum inflammatory cytokines such as C-reactive protein, interleukin-6 and tumor necrosis factor-alpha in the two groups were significantly lower than those before operation(all P<0.05), but there were no statistically significant differences between the two groups before and after operation (all P>0.05). The rates of reoperation in the observation group and control group were 8.70% and 4.35%, respectively, and there was no statistically significant difference between the two groups (P>0.05).@*Conclusion@#Stage I resection and anastomosis can be used to treat intestinal obstruction effectively, dissect lymph nodes, suppress inflammatory reaction, it is safe and reliable, and do not increase the risk of reoperation.Compared with stage I resection and anastomosis, it has more advantages in accelerating postoperative recovery, which is beneficial to reduce the cost of treatment and reduce the economic burden of patients.
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Objective To study and evaluate the clinical effect of emergency primary resection and anastomosis in the treatment of obstructive left hemicolon carcinoma and the value of preventing reoperation .Methods From February 1st 2013 to February 1st 2018, a total of 46 patients with obstructive left hemicolon cancer underwent surgical treatment were selected in the First Peopleˊs Hospital of Jinzhong.According to the random digital table method,46 patients with obstructive left colon cancer were randomly divided into two groups ,with 23 patients in each group.The control group received stage colon resection and anastomosis ,and the observation group received stage I resection and anastomosis.The operative condition ,postoperative recovery ,anastomotic leakage,therapeutic effect of intestinal obstruction, serum inflammatory cytokines and reoperation rate were compared between the two groups . Results There were no statistically significant differences in the number of lymph nodes dissection ,the amount of blood lost during operation and time of operation (all P＞0.05).The recovery time of anal exhaust [(2.34 ±0.86)d], the removal time of drainage tube[(4.36 ±1.52) d],the active time of getting out of bed [(3.81 ±1.17) d],the hospitalization time[(12.05 ±2.73)d] in the observation group were significantly shorter than those in the control group[(3.29 ±1.05)d,(6.17 ±1.84)d,(5.24 ±1.43)d,(15.76 ±3.69)d]( t＝3.357,3.637,3.712,3.876,all P＜0.05).The incidence rate of anastomotic fistula in the observation group was not significantly higher than that in the control group (P＞0.05),and there was no statistically significant difference in the total effective rate of intestinal obstruction treatment between the two groups ( P ＞0.05 ).The levels of serum inflammatory cytokines such as C－reactive protein,interleukin－6 and tumor necrosis factor －alpha in the two groups were significantly lower than those before operation ( all P＜0.05),but there were no statistically significant differences between the two groups before and after operation (all P＞0.05).The rates of reoperation in the observation group and control group were 8.70%and 4.35%,respectively,and there was no statistically significant difference between the two groups ( P＞0.05).Conclusion Stage I resection and anastomosis can be used to treat intestinal obstruction effectively ,dissect lymph nodes,suppress inflammatory reaction , it is safe and reliable, and do not increase the risk of reoperation. Compared with stage I resection and anastomosis ,it has more advantages in accelerating postoperative recovery ,which is beneficial to reduce the cost of treatment and reduce the economic burden of patients .
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PURPOSE: Although linear-shaped gastroduodenostomy (LSGD) was reported to be a feasible and reliable method of Billroth I anastomosis in patients undergoing totally laparoscopic distal gastrectomy (TLDG), the feasibility of LSGD for patients undergoing totally robotic distal gastrectomy (TRDG) has not been determined. This study compared the feasibility of LSGD in patients undergoing TRDG and TLDG.MATERIALS AND METHODS: ALL C: onsecutive patients who underwent LSGD after distal gastrectomy for gastric cancer between January 2009 and December 2017 were analyzed retrospectively. Propensity score matching (PSM) analysis was performed to reduce the selection bias between TRDG and TLDG. Short-term outcomes, functional outcomes, learning curve, and risk factors for postoperative complications were analyzed.RESULTS: This analysis included 414 patients, of whom 275 underwent laparoscopy and 139 underwent robotic surgery. PSM analysis showed that operation time was significantly longer (163.5 vs. 132.1 minutes, P<0.001) and postoperative hospital stay significantly shorter (6.2 vs. 7.5 days, P<0.003) in patients who underwent TRDG than in patients who underwent TLDG. Operation time was the independent risk factor for LSGD after intracorporeal gastroduodenostomy. Cumulative sum analysis showed no definitive turning point in the TRDG learning curve. Long-term endoscopic findings revealed similar results in the two groups, but bile reflux at 5 years showed significantly better improvement in the TLDG group than in the TRDG group (P=0.016).CONCLUSIONS: LSGD is feasible in TRDG, with short-term and long-term outcomes comparable to that in TLDG. LSGD may be a good option for intracorporeal Billroth I anastomosis in patients undergoing TRDG.
Subject(s)
Humans , Bile Reflux , Gastrectomy , Gastroenterostomy , Laparoscopy , Learning Curve , Length of Stay , Methods , Postoperative Complications , Propensity Score , Retrospective Studies , Risk Factors , Robotic Surgical Procedures , Selection Bias , Stomach NeoplasmsABSTRACT
Objective To investigate the effect of tubular gastric anastomosis on delayed gastric emptying and reflux esophagitis after radical gastrectomy. Methods From January 2014 to June 2017, 142 patients with radical gastrectomy were selected from our hospital. The patients were divided into observation group (71 cases) and control group (71 cases) according to the mode of anastomosis. In the control group, the residual stomach and esophagus were directly anastomosed with anastomat, and in the observation group patients were treated with tubular gastric anastomosis after operation. The postoperative exhaust time, operation time and hospital stay, postoperative infection and abdominal bleeding, postoperative reflux esophagitis and postoperative gastric emptying disorder were compared between the two groups. Results Postoperative exhaust time, operation time and postoperative hospitalization time showed no significant difference in two groups of patients (P>0.05); the incidence rate of reflux esophagitis in observation group was more than that in the control group : 29.58％(21/71) vs. 47.89％(34/71) (P<0.05);the postoperative gastric emptying rate in observation group was more than that in the control group:4.23％(3/71) vs. 19.72％(14/71) (P<0.01). Conclusions Tubular gastric anastomosis can significantly reduce the gastric emptying disorder and reflux esophagitis after radical gastrectomy, which is worthy of further clinical study.
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ABSTRACT Background : In recent years, a surgical technique known as single-anastomosis gastric bypass or mini-gastric bypass has been developed. Its frequency of performance has increased considerably in the current decade. Aim : To describe the mini-gastric bypass technique, its implementation and preliminary results in a university hospital. Methods : This is an ongoing prospective trial to evaluate the long-term effects of mini-gastric bypass. The main features of the operation were: a gastric pouch with about 15-18 cm (50-150 ml) with a gastroenteric anastomosis in the pre-colic isoperistaltic loop 200 cm from the duodenojejunal angle (biliopancreatic loop). Results : Seventeen individuals have undergone surgery. No procedure needed to be converted to open approach. The overall 30-day morbidity was 5.9% (one individual had intestinal obstruction caused by adhesions). There was no mortality. Conclusion : Mini-gastric bypass is a feasible and safe bariatric surgical procedure.
RESUMO Racional : Nos últimos anos foi desenvolvida técnica cirúrgica conhecida como derivação gástrica com anastomose única ou mini-bypass gástrico. A frequência com que este procedimento vem sendo realizado aumentou consideravelmente na última década. Objetivo : Descrever a técnica do procedimento, sua implementação e resultados preliminares em um hospital universitário. Métodos : Estudo prospectivo em andamento para avaliar os efeitos em longo prazo do mini-bypass gástrico. As principais características do mini-bypass gástrico laparoscópico foram: uma bolsa gástrica com cerca de 15-18 cm (50-150 ml) com anastomose gastroentérica em alça isoperistáltica pré-cólica a 200 cm do ângulo duodenojejunal (alça biliopancreática). Resultados : Foram operados 17 pacientes. Nenhum procedimento necessitou conversão para laparotomia. A morbidade global em 30 dias foi de 5,9% (um caso de obstrução por brida). Não houve mortalidade. Conclusão : O mini-bypass gástrico é procedimento cirúrgico bariátrico factível e seguro.
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Humans , Male , Female , Gastric Bypass/methods , Obesity/surgery , Prospective Studies , Treatment OutcomeABSTRACT
Abstract Purpose: To develop a model of gastroenterostomy and to analyze the acquisition of skills after training by simulation. Methods: Experimental longitudinal study and of a quantitative character. The sample consisted of twelve general surgery residents from four hospitals. The training consisted of making ten anastomoses divided equally into five sessions and it took place over a period of six weeks. The evaluation of the anastomoses considered the time and the analysis of the operative technique through the global evaluation scale Objective Structured Assessment of Technical Skills (OSATS). Results: Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The correlation index of 0.545 and 0.497 showed a high linear correlation between time variables and OSATS. Conclusion: The preparation of ten gastroenterostomies is an exercise capable of transferring basic and advanced skills in laparoscopy through a standardized training using synthetic organs and a simulator.
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Humans , Male , Female , Adult , General Surgery/education , Gastroenterostomy/education , Laparoscopy/education , Simulation Training/methods , Internship and Residency , Longitudinal Studies , Models, AnatomicABSTRACT
A retrospective study was conducted based on the clinical data of 15 choledocholith patients after Billroth-Ⅱgastroenterestomy who were treated with endoscopic retrograde cholangio-pancreatography (ERCP) through colonoscopy or duodenoscopy.It showed that choledocholith removed by colonoscopy for patients with Billroth-Ⅱ gastroenterestomy can achieve comparable therapeutic effect,but this method can reduce the operation difficulty,shorten the operation time and significantly increase the success rate.
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ObjectiveTo investigate the safety of endoscopic retrograde cholangiopancreatography (ERCP) after Billroth-Ⅱ gastrectomy. MethodsA total of 43 patients who were admitted to our hospital and underwent Billroth-Ⅱ gastrectomy from June 2012 to June 2015 were enrolled and underwent ERCP. ResultsOf all 43 patients undergoing ERCP, 39 (90.7%) received successful intubation, 2 (4.7%) received failed intubation, and 2 (47%) experienced the complication of digestive tract perforation. Among the 39 patients who underwent ERCP, 31 (79.5%) were diagnosed with common bile duct stones (3 underwent sphincterotomy and 28 underwent endoscopic papillary balloon dilation to remove stones), 6 (15.4%) were diagnosed with benign stenosis at the end of bile duct (4 underwent papillary balloon dilation alone and 2 underwent biliary plastic stent implantation), and 1 patient each (2.6%) was diagnosed with ampullary tumor and hepatic portal metastasis of gastric cancer and received implantation of metal and plastic stents, respectively. One patient (26%) experienced acute pancreatitis after surgery. ConclusionERCP is safe and effective in patients after Billroth-Ⅱ gastrectomy and holds promise for clinical application.
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PURPOSE: Peptic ulcer disease (PUD) remains one of the most prevalent gastrointestinal diseases and an important target for surgical treatment. Laparoscopy applies to most surgical procedures; however its use in elective peptic ulcer surgery, particularly in cases of pyloric stenosis, has not been popular. The aim of this study was to describe the role of laparoscopic surgery and an easily performed procedure for pyloric stenosis. We accordingly performed laparoscopic truncal vagotomy with gastrojejunostomy in 10 consecutive patients with pyloric stenosis. METHODS: Data were collected prospectively from all patients who underwent laparoscopic truncal vagotomy with gastrojejunostomy from August 2009 to May 2014 and reviewed retrospectively. RESULTS: A total of 10 patients underwent laparoscopic trucal vagotomy with gastrojejunostomy for peptic ulcer obstruction from August 2009 to May 2014 in oo university hospital. The mean age was 62.6 (+/-16.4) years old and mean BMI was 19.3 (+/-2.5) kg/m2. There were no conversions to open surgery and no occurrence of intra-operative complications. The mean operation time was 107 (90~130) minutes and blood loss was < 20 ml. Oral feeding was permitted for most patients on day 3 post operatively after upper gastrointestinal series to confirm no leakage or passage disturbance. The mean hospital stay was 7.3 days, the mean follow up duration was 19.8 (+/-17.2) months, and there was no mortality related to the operation. CONCLUSION: Laparoscopic truncal vagotomy and gastrojejunostomy was a good, easily performed surgical choice for patients with duodenal ulcer stricture.
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Humans , Constriction, Pathologic , Duodenal Ulcer , Follow-Up Studies , Gastric Bypass , Gastroenterostomy , Gastrointestinal Diseases , Laparoscopy , Length of Stay , Mortality , Peptic Ulcer , Prospective Studies , Pyloric Stenosis , Retrospective Studies , Vagotomy , Vagotomy, TruncalABSTRACT
Objective To evaluate the efficacy and safety of endoscopic retrograde cholangiopancre-atography (ERCP)by using a duodenoscope in patients with prior Billroth Ⅱ gastrectomy.Methods Data of 98 patients(including 7 who underwent Billroth Ⅱand Braun)with prior Billroth Ⅱ gastrectomy who un-derwent ERCP from January 2008 to May 2014 at Endoscopy Center of Ruijin Hospital were retrospectively studied.Results A total of 98 patients accepted 111 ERCP procedures,the overall success rate was 75.7%(84 /111).The success rate of accessing Vater′s papilla was 82.0%(91 /111)and the selective can-nulations success rate was 92.3%(84 /91).In the cases of successful access,therapeutic procedures were achieved in 100.0%(84 /84)of all patients.The overall rate of complications was 4.5%(5 /111),with mild post-procedure pancreatitis occurring in 3 cases,cholangitis in 2 cases,respectively.Conclusion ERCP u-sing a duodenoscope can be safely and effectively performed in patients with prior Billroth Ⅱ gastrectomy with high cannulation and treatment success rates.
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Objective To study the effect of surgery combined with 125I radioactive particles and chemotherapy in advanced gastric antrum cancer. Methods The data of 45 patients with advanced gastric antrum cancer were collected. The nutritional status, quality of life and survival time of patients in surgery combined with 125I radioactive particles and chemotherapy group (group A, 23 cases) and chemotherapy group (group B, 22 cases) were compared. Results The average period that patients canˊt eat through the mouth in group A was 10.22 months, it was 6.32 months in group B, and the difference between group A and group B was statistically significant (t= 3.765, P= 0.001). There were statistically differences in quality of life scores between the two groups at 3rd month and 9th month [3rd months: (73.48 ±19.21) scores vs (59.09 ± 24.86) scores, t= 2.178, P= 0.035; 9th month: (42.17±14.55) scores vs (32.05±21.10) scores, t= 3.43, P=0.001]. There were statistically differences in nutritional status between the two groups at 3rd month and 9th month (χ2 = 9.846, P= 0.020; χ2 = 7.713, P= 0.049). At 9th months, 7 patients died in group A and 13 patients died in group B, and there was a difference between the two groups (χ2= 3.964, P= 0.046). The overall survival rates of 12 months in two groups had not difference (P= 0.119). Conclusion The treatment of surgery combined with 125I radioactive particles and chemotherapy can improve the nutritional status and quality of life in patients with advanced gastric antrum cancer, and extend life appropriately in one year.
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Duodenal trauma is an infrequent injury, but linked to high morbidity and mortality. Surgical management of duodenal injuries is dictated by: patient's hemodynamic status, injury severity, time of diagnosis, and presence of concomitant injuries. Even though most cases can be treated with primary repair, some experts advocate adjuvant procedures. Pyloric exclusion (PE) has emerged as an ancillary method to protect suture repair in more complex injuries. However, the effectiveness of this procedure is debatable. The "Evidence Based Telemedicine - Trauma & Acute Care Surgery" (EBT-TACS) Journal Club performed a critical appraisal of the literature and selected three relevant publications on the indications for PE in duodenal trauma. The first study retrospectively compared 14 cases of duodenal injuries greater than grade II treated by PE, with 15 cases repaired primarily, all of which penetrating. Results showed that PE did not improve outcome. The second study, also retrospective, compared primary repair (34 cases) with PE (16 cases) in blunt and penetrating grade > II duodenal injuries. The authors concluded that PE was not necessary in all cases. The third was a literature review on the management of challenging duodenal traumas. The author of that study concluded that PE is indicated for anastomotic leak management after gastrojejunostomies. In conclusion, the choice of the surgical procedure to treat duodenal injuries should be individualized. Moreover, there is insufficient high quality scientific evidence to support the abandonment of PE in severe duodenal injuries with extensive tissue loss.
O trauma duodenal é incomum, mas possui alta morbimortalidade. As condições clínicas dos pacientes, gravidade das lesões, tempo de diagnóstico e lesões associadas influenciam na escolha do procedimento operatório. A maioria das lesões duodenais é tratada com reparo primário. Procedimentos adjuvantes para proteger a linha de sutura e evitar deiscência podem ser úteis em lesões complexas. Embora a exclusão pilórica (EP) seja utilizada em lesões duodenais graves, há controvérsia quanto a sua necessidade. A reunião "Telemedicina Baseada em Evidências - Cirurgia do Trauma e Emergência" (TBE-CiTE) revisou a literatura e selecionou três publicações relevantes sobre as indicações de EP no trauma duodenal. O primeiro estudo, retrospectivo, comparou 14 pacientes com ferimentos penetrantes duodenais grau > II, tratados com EP, com 15 pacientes semelhantes tratados com reparo primário; não houve diferença nos resultados. O segundo, também retrospectivo, comparou o reparo primário (34 casos) com EP (16 casos), em lesões duodenais contusas ou penetrantes grau > II. Os autores concluíram que a EP não é necessária para todos os pacientes, apesar de lesões duodenais graves. O terceiro estudo constituiu-se de revisão da literatura sobre os desafios do tratamento dos traumatismos duodenais. Na experiência do autor, a EP é útil nos casos de fístula de anastomoses gastrojejunais. Conclui-se que a escolha do procedimento operatório no tratamento das lesões duodenais deve ser individualizada. Não há evidência cientifica de boa qualidade para justificar o abandono da EP no tratamento das lesões duodenais graves com grande perda tecidual.
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Humans , Duodenum/injuries , Duodenum/surgery , Pylorus , Digestive System Surgical Procedures/methods , Injury Severity ScoreABSTRACT
BACKGROUND: The association between obesity and gastroesophageal reflux disease has a high incidence and may be present in half of obese patients with surgical indication. Bariatric operations can also induce reflux alone - differently from BMI factors - and its mechanisms are dependent on the type of procedure performed. OBJECTIVE: To perform a literature review comparing the two procedures currently most used for surgical treatment of obesity and analyze their relationship with the advent of pre-existing reflux disease or its appearance only in postoperative period. METHOD: The literature was reviewed in virtual database Medline/PubMed, SciELO, Lilacs, Embase and Cochrane crossing the following MeSH descriptors: gastric bypass AND / OR anastomosis, Roux-en-Y AND / OR gastroesophageal reflux AND / OR gastroenterostomy AND / OR gastrectomy AND / OR obesity AND / OR bariatric surgery AND / OR postoperative period. A total of 135 relevant references were considered but only 30 were used in this article. Also was added the experience of the authors of this article in handling these techniques on this field. CONCLUSION: The structural changes caused by surgical technique in vertical gastrectomy shows greater commitment of antireflux mechanisms predisposing the induction of GERD postoperatively compared to the surgical technique performed in the gastrointestinal Bypass Roux-en-Y. .
INTRODUÇÃO: A associação entre obesidade e doença do refluxo gastroesofágico apresenta alta incidência e pode estar presente em metade dos obesos com indicação cirúrgica. Operações bariátricas podem também induzir refluxo por si só - de modo diferente do fator IMC -, e seus mecanismos são dependentes do tipo do procedimento realizado. OBJETIVO: Efetuar revisão bibliográfica comparando os dois procedimentos atualmente mais utilizados para tratamento cirúrgico da obesidade e analisar a relação deles com o advento de doença do refluxo gastroesofágico pré-existente ou de surgimento somente no pós-operatório. MÉTODO: Foi realizada revisão bibliográfica nas bases virtuais Medline/Pubmed, Scielo, Lilacs, Embase e Cochrane cruzando os seguintes descritores MeSH: gastric bypass AND/OR anastomosis, Roux-en-Y AND/OR gastroesophageal reflux AND/OR gastroenterostomy AND/OR gastrectomy AND/OR obesity AND/OR bariatric surgery AND/OR postoperative period. Foram consideradas pertinentes 135 referências e utilizadas 30 neste artigo. Também foi adicionada a experiência dos autores deste artigo no manuseio dessas técnicas com esse mister. CONCLUSÃO: As alterações estruturais causadas pela técnica operatória na gastrectomia vertical apresenta maior comprometimento dos mecanismos anti-refluxo predispondo a indução da DRGE no pós-operatório quando comparado à técnica operatória realizada no Bypass gastrointestinal em Y-de-Roux. .
Subject(s)
Humans , Gastrectomy/adverse effects , Gastrectomy/methods , Gastric Bypass/adverse effects , Gastroesophageal Reflux/etiology , Obesity/surgeryABSTRACT
Objective To evaluate the safety and efficacy of the technique of transoral Orvil EEA stapler (OrVil) for laparoscopic gastrectomy of gastric cancer in our hospital.Methods Between Sep 2012 and Aug 2013,73 patients at our department underwent open (n =36) or laparoscopic (being reconstructed by OrVil,n =37) gastrectomy.Early surgical outcomes of the two groups were compared to assess the effectiveness,security and postoperative complications of OrVil procedure.Results The two groups had similar mean numbers of dissected lymph nodes (29 ± 10 vs.31 ± 14,t =-0.697,P =0.488),lengths of postoperative hospital stay (14 ± 5 vs.12 ± 3 d,t =1.933,P =0.057) and postoperative complications (11 vs.11,P =0.939).Intraoperative blood loss was significantly less (189 ± 79 vs.343 ± 90 ml,t =-7.782,P =0.000) and time to first flatus significantly shorter (2.9 ±0.5 vs.3.5 ±0.6 d,t =-4.714,P =0.000) with the use of OrVil.Operation time of laparoscopic group was significantly longer than that of open group (266 ± 97 vs.204 ± 39 min,t =3.607,P =0.001).There was one each anastomotic leakage in both groups.Conclusions With the suitable approach and skillful technique,OrVil is a technically safe and feasible surgical procedure for the treatment of gastric cancer.
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Objective To evaluate the safety and feasibility of totally laparoscopic radical distal gastrectomy (TLDG)and intracorporeal gastroduodenostomy using laparoscopic linear staplers in gastric cancer patients.Methods Clinical data were reviewed on the perioperative outcomes of 17 gastric cancer patients who received totally laparoscopic distal gastrectomy and intracorporeal gastroduodenostomy using endoscopic linear staplers from June 2012 to June 2013 at Department of General Surgery,Lishui Central Hospital.Results The mean operation time were (2.6 ± 0.4) h,TLDG with deltashaped anastomosis was successfully carried out in all the patients except for 1 case who was converted to open surgery.There was no serious complication and no death in this series.The postoperative pain in TLDG was less than laparoscopy assisted distal gastrectomy.Conclusions Totally laparoscopic distal gastrectomy and intracorporeal gastroduodenostomy using endoscopic linear staplers is a new method with high safety and feasibility.
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Objective To evaluate the therapeutic effect and safety of forward-viewing,doublechannel endoscope in the process of ERCP in patients with bile duct diseases after Billroth-Ⅱ gastroenterostomy.Methods ERCP was applied to 46 patients with bile duct diseases using forward-viewing,doublechannel endoscope.All patients had the history of Billroth-Ⅱ gastroenterostomy.The success rate of selective cannulation,complication rate and the outcome of all the patients were recorded.Results The procedure succeeded in 38 patients with a success rate of 82.6％,and failed in 8.Of all the failing cases,the afferent loop couldn't be accessed in 6,failure in biliary cannulation in 2.Of 38 successful cases,bile duct stones were successfully removed in 31,metal stents placed for malignant bile duct obstruction in 4,and endoscopic balloon dilation for benign common bile duct stricture in 3.All patients recovered without complications of perforation,delayed bleeding or pancreatitis.Conclusion For patients with history of Billroth-Ⅱgastroenterostomy,ERCP with forward-viewing,double-channel endoscope yields to a higher success rate and lower complication rate.
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Objective To research a new type of gastrointestinal anastomat -- anastomosis device with three rows of staples (Pa-tent No .2012200583213) ,and clarify its associated functions through esophagogastric anastomosis operations on pigs ,so that we could provide experiences for its clinical application in future .Methods Compared with domestic anastomat with two rows of sta-ples ,we designed and manufactured a new type of anastomat with three rows of staples and researched its function .Choosing 12 do-mestic pigs ,about 60 kg ,gastroesophageal anastomosis was taken twice with each case by anastomat with three or two rows of sta -ples randomly in sequence .According to the different types of anastomats ,cases were divided into two groups :group A ,used anas-tomat with three rows of staples ,including 12 cases of anastomosis ;group B ,used anastomat with two rows of staples ,including an-other 12 cases of anastomosis .Results Compared with group B ,cases of group A have less bleeding sites (t = 7 .00 ,P < 0 .01) . Without reinforcement and with 0 .5 kg of tension ,fewer of outermost staples exposed(t= 6 .17 ,P< 0 .01) .And the shape of used staples of group A is double circles ,which has bigger mechanical strength than that of group B (t= 6 .57 ,P < 0 .01) .Conclusion The function of anastomat with three rows of staples surpasses that of traditional anastomat with two rows of staples in pig esopha -gogastrostomy surgery .