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Dong Jin Park, Byung Gyu Kim, In Du Jeong, Gyu Yeol Kim
A 58-year-old man underwent laparoscopy-assisted distal gastrectomy (LADG) with Billroth I gastroduodenostomy due to early gastric cancer. During surgery, the perigastric vessels were ligated with Hem-o-Lok clips. Esophagogastroduodenoscopy (EGD) 6 months later showed a fungating mass at the anastomosis site. Repeat EGD 1 year after LADG showed a Hem-o-Lok clip at the fungating mass lesion. Because the patient was asymptomatic, with no major abnormalities on clinical examination, and endoscopic removal of the clip would have been difficult due to the presence of adhesions and inflammation, no attempt was made to remove the clip...
March 2018: Annals of Surgical Treatment and Research
Stuart K Amateau, Chin Hong Lim, Nicholas M McDonald, Mustafa Arain, Sayeed Ikramuddin, Daniel B Leslie
Traditionally, restoration of normal bowel continuity after resection and bypass of a diseased or obstructed gastrointestinal tract can only be achieved through surgery, which can be technically challenging and comes with a risk of adverse events. Here, we describe our institutions' experience with endoscopic-guided gastroenterostomy or enteroenterostomy with lumen-apposing metal stent (LAMS) from March 2015 to August 2016. Ten patients had gastrogastrostomy (gastric pouch to gastric remnant) and three patients had jejunogastrostomy (Roux limb to gastric remnant) for the reversal of Roux-en-Y bariatric surgery...
March 2, 2018: Obesity Surgery
Takaya Tokuhara, Eiji Nakata, Toshiyuki Tenjo, Isao Kawai, Keisaku Kondo, Hirofumi Ueda, Atsushi Tomioka
We report an option for delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. We detail a single-layer suturing technique for the endoscopic linear stapler entry hole using knotless barbed sutures combined with the application of additional knotted sutures. From June 2013 to February 2017, we performed TLDG with delta-shaped gastroduodenostomy in 20 patients with gastric cancer. The linear stapler was closed and fired to attach the posterior walls of the remnant stomach and the duodenum together...
January 2018: Oncology Letters
Yoon Young Choi, Sung Hoon Noh, Ji Yeong An
The purpose of this study is to compare the effect of diabetes control induced by Roux-en-Y gastrojejunostomy(RY) vs Billroth-I reconstruction(BI) after distal gastrectomy in patients with early gastric cancer(EGC) and type 2 diabetes(T2DM). Forty EGC patients with T2DM, aged 20-80 years, who were expected to undergo curative distal gastrectomy were randomized 1:1 to RY(n = 20) or BI(n = 20). Diabetes medication status, biochemical and hormonal data including blood glucose, HbA1c, insulin, C-peptide, HOMA-IR, ghrelin, leptin, GLP-1, PYY, and GIP were evaluated for 12 months after surgery...
2017: PloS One
Sang-Woong Lee, Masaru Kawai, Keitaro Tashiro, George Bouras, Satoshi Kawashima, Ryo Tanaka, Eiji Nomura, Kazuhisa Uchiyama
In 1994, Kitano and colleagues first reported laparoscopy-assisted Billroth I gastrectomy. Since then, laparoscopic gastrectomy (LG) has been associated with earlier patient recovery compared with open surgery, and has gained increasing international acceptance. Japan Society of Endoscopic Surgery biennial surveys confirm the increasing use of laparoscopic procedures for treatment of gastric cancer in Japan. Its thirteenth national survey indicates that of 31,264 patients treated at Japanese institutions in 2015, approximately 9,500 (30...
2017: Translational Gastroenterology and Hepatology
Zirui He, Lu Zang
After the advent of the concept of laparoscopic assisted distal gastrectomy (LADG), the digestive reconstruction poses arguments among surgeons. There are three major different ways including Billroth I gastroduodenostomy, Billroth II gastrojejunostomy and Roux-en-Y gastrojejunostomy, and each of them has its own trick. In this article, the technical tips and pitfalls of each reconstruction will be discussed based on studies and author's experience.
2017: Translational Gastroenterology and Hepatology
Rana Alhossaini, Woo Jin Hyung
Situs inversus totalis (SIT) is a relatively rare condition where the abdominal and/or thoracic organ is positioned as a "mirror image" of the normal position. We are presenting a video of robotic distal gastrectomy performed in a 52-year-old female known to have SIT. Preoperative investigations revealed the patient has an early gastric cancer at the antrum. Ports were placed as mirror image to our usual port placement and upon exploration, the liver is visualized on the left side of the abdomen and the spleen is on the right...
December 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Jun Hong, Ya-Ping Wang, Jian Wang, Yi-Bing Bei, Lu-Chun Hua, Han-Kun Hao
BACKGROUND: We developed a modified delta-shaped gastroduodenostomy technique in totally laparoscopic distal gastrectomy. This novel technique, which effectively reduces the required quantity of linear stapler [1-3], was named as self-pulling and latter transected delta-shaped anastomosis (Delta SPLT) [4]. METHODS: Delta SPLT was performed on 15 patients with stage cT1-2 antral cancer. We ligated the duodenum with a rope instead of transecting it and used the ligature rope to pull the duodenum during the whole progress of gastroduodenostomy...
November 2017: Surgical Endoscopy
Eun Jung Shim, Sung Eun Ahn, Dong Ho Lee, Seong Jin Park, Youn Wha Kim
Inflammatory fibroid polyp (IFP) is a rare benign lesion of the gastrointestinal tract. We report a case of computed tomography (CT) imaging finding of a gastric IFP with massive fibrosis. CT scans showed thickening of submucosal layer with overlying mucosal hyperenhancement in the gastric antrum. The submucosal layer showed increased enhancement on delayed phase imaging. An antrectomy with gastroduodenostomy was performed because gastric cancer was suspected, particularly signet ring cell carcinoma. The histopathological diagnosis was an IFP with massive fibrosis...
March 21, 2017: World Journal of Gastroenterology: WJG
Gonul Kucuk, Gulnur Gollu, Ufuk Ates, Zeynep A Cakmak, Meltem Kologlu, Aydın Yagmurlu, Tanju Aktug, Huseyin Dindar, Ahmet M Cakmak
Esophageal or gastric injuries secondary to caustic substance ingestion is still an important issue in developing countries. Its clinical spectrum can vary from absence of mucosal injury to complications such as severe burns, strictures and perforation. Physical examination and first endoscopic evaluation are very important in the diagnosis. The objective of this study is to present 154 children who were undergone upper gastrointestinal endoscopy because of caustic substance ingestion including descaler, degreaser, unlabeled bleach, drain opener, surface cleaner, dishwasher rinse aid, hydrochloric acid...
April 1, 2017: Archivos Argentinos de Pediatría
Sojung Han, Hyunsoo Chung, Jun Chul Park, Sung Kwan Shin, Sang Kil Lee, Yong Chan Lee
Gastrointestinal (GI) leakage, fistulae, and perforations can be serious and life threatening. There has been a paradigm shift in the management approach of these conditions, from surgical to conservative, including endoscopic management. Here, we report two cases of endoscopic closure of a GI fistula and perforation using polyglycolic acid (PGA) sheets with fibrin glue. The first case is of an anastomotic leak detected after subtotal gastrectomy with gastroduodenostomy. After failed application of endoclips, a PGA sheet was applied, and the fistula was successfully closed...
May 2017: Clinical Endoscopy
Chie Tanaka, Michitaka Fujiwara, Mitsuro Kanda, Kenta Murotani, Naoki Iwata, Masamichi Hayashi, Daisuke Kobayashi, Suguru Yamada, Goro Nakayama, Hiroyuki Sugimoto, Masahiko Koike, Tsutomu Fujii, Yasuhiro Kodera
INTRODUCTION: Laparoscopy-assisted distal gastrectomy is one of the major treatments for early stage gastric cancer, particularly in the East Asia. In this method, extracorporeal anastomosis is performed via a small laparotomy wound, but excessive tissue traction may be encountered during the anastomotic procedure. Therefore, we developed an original procedure for extracorporeal Billroth-I reconstruction: end-to-end stapling gastroduodenostomy with complete double stapling technique. This procedure aims to reduce the problems related to maneuvers through a small laparotomy...
January 27, 2017: Asian Journal of Endoscopic Surgery
Doo Hwan Kim, Jun Young Park, Myong-Hwan Karm, Heon-Yong Bae, Jae-Young Lee, Ho Soo Ahn, Kunhee Lee, Jeong Gil Leem
OBJECTIVES: Although nicotine has an analgesic effect, the incidence and severity of chronic pain is higher in smokers than nonsmokers. Acute pain is more intense in smokers during the perioperative period. This study evaluated whether smokers require higher doses of opioid to reduce pain when they undergo surgery. METHODS: A retrospective review of 236 patients who had intravenous patient-controlled analgesia after distal gastrectomy with gastroduodenostomy between October 2013 and September 2014 was performed to analyze the difference in postoperative opioid requirements between smokers and nonsmokers...
October 2017: Clinical Journal of Pain
Shu-Yan Wang, Jun Hong, Han-Kun Hao
BACKGROUND: Delta-shaped anastomosis (DA) is a newly developed intracorporeal gastroduodenostomy. This meta-analysis is performed to compare the safety, feasibility and clinical outcomes of DA with conventional extracorporeal Billroth I anastomosis (B-I) after laparoscopic distal gastrectomy for gastric cancer. METHODS: Both randomized controlled trials (RCTs) and nonrandomized cohort studies comparing outcomes of DA and B-I after laparoscopic distal gastrectomy for gastric cancer were searched in electronic database...
August 2017: Surgical Endoscopy
Dooin Lee, Jae Hoon Lee, Dongho Choi, Chang Moo Kang, Jae Uk Chong, Song-Chul Kim, Kyeong Geun Lee
BACKGROUND: Stomach cancer is the second most commonly diagnosed cancer in Korea. Although the long-term survival outcome has improved, secondary primary tumors from periampullary regions are increasing inevitably and pancreaticoduodenectomy (PD) following gastrectomy is challenging. This study evaluates the surgical outcomes of PD following gastrectomy and suggests the optimum method for reconstruction. METHODS: Patients who underwent curative PD with a history of gastric resection between 2005 and 2015 were assessed retrospectively...
February 2017: World Journal of Surgery
Geng-Yuan Hu, Feng Tao, Ke-Wei Ji, Wei Wang
OBJECTIVE: The aim of this systematic review and meta-analysis is to evaluate the safety and relative benefits of delta-shape anastomosis (DA) by comparing to conventional laparoscopy-assisted distal gastrectomy with Billroth I gastroduodenostomy (LADG BI). METHODS: Studies and relevant literature regarding DA versus LADG BI were searched in the electronic databases. Operation time, postoperative complications, estimated blood loss, number of retrieved lymph nodes, time to first flatus, time to oral intake, length of postoperative hospitalization in DA and LADG BI were pooled and compared using meta-analysis...
2016: PloS One
Yuichi Takayama, Yuji Kaneoka, Atsuyuki Maeda, Yasuyuki Fukami, Shunsuke Onoe
BACKGROUND: Various methods of reconstruction after laparoscopic distal gastrectomy (LDG) have been developed and reported. In open gastrectomy, gastroduodenostomy or gastroenterostomy is often performed with the hand-sewn technique. Therefore, hand-sewn anastomosis was performed through a small incision in LDG. The aim of this study was to evaluate the feasibility and safety of LDG with hand-sewn anastomosis. METHODS: Between June 2009 and December 2015, we assessed 263 consecutive patients who underwent LDG in our institution...
July 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Jiaming Zhu, Weidong Zang, Lu Zang, Yong Li
OBJECTIVE: To investigate the feasibility and safety of uncut Roux-en-Y gastroduodenostomy in totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. METHODS: Clinical data of 30 gastric cancer patients from 4 hospitals undergoing TLDG plus uncut Roux-en-Y gastroduodenostomy from February 2014 to January 2015 were analyzed retrospectively. RESULTS: Among 30 gastric cancer patients, 8 were in Guangdong General Hospital, 9 in The Second Hospital of Jilin University, 4 in Ruijin Hospital and 9 in Fujian Provincial Cancer Hospital, who were diagnosed as distal gastric cancer by pathology without distant metastasis...
August 25, 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Nobuhisa Matsuhashi, Kazuya Yamaguchi, Naoki Okumura, Toshiyuki Tanahashi, Satoshi Matsui, Hisashi Imai, Yoshihiro Tanaka, Takao Takahashi, Shinji Osada, Kazuhiro Yoshida
BACKGROUND: The indications for laparoscopic gastrectomy for early stomach cancer have spread worldwide, and the short-term outcomes have been favorable. Intraabdominal delta-shaped gastroduodenostomy using endoscopic linear staplers, a technique which was developed by Kanaya et al. is one of the feasible reconstructive procedures. Pure laparoscopic surgery is reported to be associated with several intraoperative and postoperative advantages in comparison with laparoscopy-assisted surgery...
March 2017: Surgical Endoscopy
Elisabetta Moggia, Panagiotis G Athanasopoulos, Christopher Hadjittofi, Stefano Berti
Pyloroplasty is currently reserved for emergencies (perforation, bleeding), but may occasionally be performed to treat benign gastric outlet obstruction (GOO). Historically, two techniques are available: the Mikulicz pyloroplasty, by which the pylorus is incised longitudinally and sutured vertically, and the Finney pyloroplasty, by which a U-shaped inverted incision is made in the second part of duodenum (D1-D2), followed by a side-to-side gastroduodenostomy. We report our experience in this single case of laparoscopic Finney pyloroplasty (LFP) performed in the emergency setting for a woman with a perforated duodenal ulcer and severe loss of tissue in D1-D2...
May 2016: Annals of Translational Medicine
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