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Objective:To systematically evaluate manual suture versus mechanical anastomosis in esophagojejunostomy, two methods of digestive tract reconstruction after laparoscopic total gastrectomy. Methods:A computer-based online search of PubMed, CBM, Wanfang database and CNKI database was performed to retrieve clinical studies related to manual suture (manual suture group) and mechanical anastomosis (mechanical anastomosis group) in esophagojejunostomy after laparoscopic total gastrectomy published between January 2015 and October 2020. The quality of eligible literature was evaluated and data were extracted for meta-analysis using Review Manager 5.4 software.Results:Four clinical studies involving 746 patients were included in the final analysis. Meta-analysis results revealed that there was no significant difference in operative time between manual suture and mechanical anastomosis methods [ MD = 8.32, 95% CI (-5.94, 22.57), P > 0.05]. The intraoperative blood loss in manual suture group was significantly less than that in mechanical anastomosis group [ MD = -9.54, 95% CI (-15.54, -3.55), P < 0.05]. The time to exhaust in the manual suture group was shorter than that in the mechanical anastomosis group [ MD = -0.38, 95% CI (-0.59, -0.18), P < 0.05]. The length of hospital stay in the manual suture group was less than that in the mechanical anastomosis group [ MD = -0.88, 95% CI (-1.23, -0.54), P < 0.05]. The incidence of anastomotic leakage in the manual suture group was significantly lower than that in the mechanical anastomosis group [ OR = 0.23, 95% CI (0.06, 0.93), P < 0.05]. The incidence of anastomotic stenosis in the manual suture group was significantly lower than that in the mechanical anastomosis group [ OR = 0.14, 95% CI (0.04, 0.54), P < 0.05]. Conclusion:After total gastrectomy, continuous suture of oesophago-jejuno ends with barbed threads under laparoscopy is safer and less expensive and needs less time to postoperative recovery and shorter length of hospital stay compared with mechanical anastomosis.
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Objective To evaluate the clinical effects of the totally laparoscopic and laparoscopic-assisted radical gastrectomy for gastric cancer,and evaluate the feasibility and safety of the two methods.Methods Eighty patients with gastric cancer undergoing radical D2 gastrectomy from Mar 2016 to Jul 2017 were enrolled.Patients were divided into totally laparoscopically hand-sewn escophagojejunostomy group (35 cases) and control group of hand-assisted laparoscopic esophagojejunostomy (45 cases).Results Compared with the control group,the operation time,blood loss,lymph node dissection in the control group were not significantly different [(256 ± 53) min vs.(248 ± 62) min,t =2.40,P ＞ 0.05;(123 ±78)ml vs.(162±56)ml,t=-1.94,P＞0.05;(28±6) vs.(30±7),t=-3.18,P＞0.05].The postoperative ambulation time,first exhaust time,postoperative hospital stay,incision complications were all in favor of the totally laparoscopic group [(1.5 ± 0.7) d vs.(2.6 ± 0.6) d,t =-2.41,P ＜ 0.05;(2.7 ±0.8)d vs.(4.0 ±1.2)d,t =-4.63,P＜0.01;(6.8 ±0.8)d vs.(9.2 ± 1.6)d,t =-7.32,P＜0.05].Conclusions Totally laparoscopic radical gastrectomy and hand-sewn esophagojejunostomy for gastric cancer is safe and reliable and has advantages such as less pain and fast recovery.
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Objective To investigate the therapeutic effects of hepatic resection plus Roux-en-Y choledochojejunostomy in combination with reflux prevention on intrahepatie bile duct stone. Methods The clinical data of 230 patients with intrahepaticbile duet stone surgically treated in our hospital in the past 18 years were retrospectively analyzed. Of the 230 patiets, 110 underwent hepatectomy plus Roux-en-Y choledochojejunostgmy in combination with reflux prevention and the others received other surgeries. The complications of pleural effusions, infection of incisional wound, leakage of bile and retained calculus after operation were studied. Meanwhile, the recurrent rate of stone and long-term effects were determined. Results The occurrinjg rate of pleural effusion, infection of incision wound,leakage of bile was not significantly different among different groups. However, the retained calculus and recurrent rate of stone in the group of patients underwent hepateetomy plus Roux-en-Y choledochojejunostomy in combination with reflux prevention were significantly decreased as compared with other group (P<0.05). So was the effect in long-term (P<0.05). Conclusion Hepatectomy plus Roux-en-Y choledochojejunostomy in combination with reflux prevention could have better effect on patients with intrahepatic bile duct stone.
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Objective To investigate whether routine exposure recurrent laryngeal nerves(RLN) during the procedure of thyreoidectomy would prevent permanent nerves injuries caused by thyroid surgery.Methods 1523 patients with thyroid disease underwent thyreoidectomy from January 1980 to December 2004.Routine exposure of RLN during the procedure of thyreoidectomy were in 274 cases(group 1) and not in 1249 cases(group 2),the incidence rates of temporary RLN injuries and permanent RLN injures were compared in these groups.Results 3 cases(3/274,1.1%) occurred permanent RLN injuries in group 1 and 47 cases(47/1249,3.8%) occurred RLN injuries in group 2.The incidence rate of permanent RLN injuries in group 1 was lower than that in group 2(P0.05) in these groups.Conclusion Exposure recurrent RLN during the procedure of thyreoidectomy can effectively prevent permanent nerves injuries caused by thyroid surgery.