A nursing care experience of using transoral Orvil EEA stapler during total laparoscopic gastrectomy / 中国实用护理杂志

Objective To summarize the nursing care and cooperation with surgeons using transoral Orvil EEA stapler during total laparoscopic gastrectomy (TLG).Methods We present our initial experience of nursing care and cooperation with surgeons for 8 patients undergoing TLG using a circular end-toside anastomosis created with the transoral directed EEA circular stapler Orvil.Results The surgeries of all 8 patients were successfully completed under our good cooperation with surgeons using the technique of Orvil system.Conclusions Good preparations and knowing well the surgical procedures were the key points to achieve success using the transoral Orvil EEA stapler for patients undergoing TLG.

Anastomosis Site Stricture after Using Stapler Devices in a Total Gastrectomy

PUPOSE: Anastomosis site stricture is a common complication after a total gastrectomy. End-to-end anastomosis (EEA) stapler devices are preferred to a hand-sewn esophagojejunostomy these days. However, stapling devices have been reported not to reduce the incidence of esophagojejunostomy site stricture considerably. MATERIALS AND METHODS: From Sep. 1998 to Dec. 2000, at Korea Gastic Cancer Center, Seoul Paik Hospital, Inje University, we experienced 228 total gastrectomies in which EEA stapling devices had been used. We investigated the correlation of the stricture with the size of the EEA stapling device, the type of esophagojejunal reconstruction, reflux esophagitis, and duration of stricture development. RESULTS: Among the 228 cases, as far as the patient's age was concerned, the 7th decade was the most common 64 cases, followed by the 5th decades. The Male-to-female ratio was 2.3 : 1. A loop esophagojejunostomy was used in 223 cases, and the Roux-en-Y method was used in 5 cases. The 32 patients with anastomosis site stricture were patients with loop esophagojejunal anastomosis. Anastomosis site stricture occurred in 14% (32/228) of the total gastrectomy cases, in15.9% (11/69) of the total gastrectomies involving stapler devices with a 25-mm diameter, and in 13.2% (21/159) of the total gastrectomies involving staper devices with a 28-mm diameter. There was no correlation between the incidence of stricture and EEA- stapling device size (P>0.05). Reflux esophagitis occurred in 56 of the 228 cases, with 7 of those 56 cases (12.5%) and 25 of the remaining 172 cases (14.5%) having strictures. There was no considerable difference in the stricture incidence rate according to the presence of reflux esophagitis (P>0.05). The onset of stricture development, occurred within 6 months in 16 cases, including 4 cases of reflux esophagitis, between 7 and 18 months in 14 cases, including 3 cases of reflux eshophagitis, and after 19 months in 2 cases. CONCLUSION: An esophagojejunostomy site stricture after a total gastrectomy was not correlated with the esophagojejunal reconstruction type, the size of the stapling device, or the presence of reflux esophagitis. General anastomosis technical factors (e.g., adequate blood supply, tension-free manner, adequate hemostasis) may be more important to prevent anastomosis site stricture after an esophagojejunostomy during a total gastrectomy.

Comparative Study of Delayed Gastric Emptying between Manual and Stapled Anastomosis in Patients Undergoing Subtotal Gastrectomy with Billroth I Gastroduodenostomy for Early Gastric Cancer

PURPOSE: Many surgeons are using stapled anastomosis in Billroth I gastroduodenostomy after subtotal gastrectomy because of the shorter operation time and simpler handling. However, many patients complain delayed gastric emptying after using EEA stapler. The delayed gastric emptying was compared between manual and stapled anastomosis in Billroth I gastroduodenostomy for stomach cancer. METHODS: 92 patients who performed Billroth I gastroduodenostomy after subtotal gastrectomy due to early gastric cancer at the Hanyang University Guri Hospital between January 2001 to December 2003 were reviewed. Delayed gastric emptying was diagnosed by patients' symptoms and upper gastrointestinal roentgenogram. Manual anastomosis was using the Albert-Lambert suturing and stapled procedure with EEA stapler (auto suture(R)). RESULTS: Of the 92 patients, 22 were in the stapled anastomosis group (a mean age of 61.58 years, M:16, F:6) and 70 in the manually anastomosis group(a mean age of 61.12 years, M: 44, F: 26). The incidence of delayed Gastric emptying were significantly lower in the manual than the stapler group (P=0.035), but the operation times and the hospitas stay were significantly shorter in stapler group (P=0.001 and 0.07, respectively). CONCLUSION: The manual group had better outcomes with regard to gastric emptying despite of the many advantages of stapled anastomosis in the filedld of intraabdominal operations. Various stapled anastomosis instruments and methods have been tried, but further studies are necessary if stapled anastomosis is to be the perfect substitute for manual anastomosis.

An Analysis of Complications according to Cartridge Size Following Total Gastrectomy with Roux-en-Y Esophagojejunostomy Using the EEA Stapler

PURPOSE: Anastomotic stricture is one of the most common problems in esophagojejunostomy using an end-to-end anastomosing (EEA) instrument following total gastrectomy. Because anastomotic stricture often develops with small- cartridge EEA, a larger EEA may be used to avoid stricture. The purpose of this retrospective study is to evaluate the difference of complications between patients treated using the EEA25 and ones using EEA28. METHODS: A total of 283 patients underwent curative total gastrectomy and esophagojejunostomy with Roux-en-Y anastomosis, using EEA25 or EEA28, between January 1992 and December 1999. The differences between the EEA25 and EEA28 groups were investigated by comparing them in terms of reflux esophagitis, dysphagia, and stricture. RESULTS: Stricture developed in five patients (13.8%) in the EEA28 group and in 11 patients (4.45%) in the EEA25 group (P<0.05), dysphagia was experienced less frequently in the EEA25 than in the EEA28 group (P<0.05), and no significant differences were evident with regards to reflux esophagitis. CONCLUSION: The choice of a large EEA to avoid anastomotic stricture did not affect the development of dysphagia or stricture. However, a randomized, prospective study should be done to better define the relationship between the size of EEA and the complications of total gastrectomy.

Comparative Study of the Manual and Stapled Anastomosis in Patients Undergoing a Billroth I Gastrectomy for Carcinoma of the Stomach

BACKGROUND : The purpose of this study was to determine whether the Billroth I method using an EEA stapler is safe, reliable, and easy-to-use for treatment of gastric cancer compared with a distal gastrectomy with conventional manual anastomosis. METHODS : A prospective comparative study was performed between forty patients with EEA stapling and thirty patients with manual suturing during gastroduodenostomies performed during the past three years with respect to operation time, diameter of anastomosis, postoperative clinical course, and post operative complications. RESULTS : The operation time was significantly shortened by about 50 minutes on the average, in the cases where the EEA stapler was used (p<0.001). On postoperative hypotonic duodenography, the diameter of the anastomosis was significantly larger in the cases where the EEA stapler was used (p< 0.001). However, the postoperative clinical course showed no difference between the two groups. Complications, such as anastomotic stenosis and anastomotic leak age were noted only in the cases where manual suturing was used. CONCLUSIONS : A gastroduodenostomy using the EEA stapler might be a faster, simpler and safer pro cedure compared with the gastroduodenostomy using the conventional manual anastomosis.