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Article in Chinese | WPRIM | ID: wpr-936060


Objective: To compare the clinical efficacy and quality of life between uncut Roux-en-Y and Billroth II with Braun anastomosis in laparoscopic distal gastrectomy for gastric cancer patients. Methods: A retrospective cohort study was performed. Inclusion criteria: (1) 18 to 75 years old; (2) gastric cancer proved by preoperative gastroscopy, CT and pathological results and tumor was suitable for D2 radical distal gastrectomy; (3) postoperative pathological diagnosis stage was T1-4aN0-3M0 (according to the AJCC-7th TNM tumor stage), and the margin was negative; (4) Eastern Cooperative Oncology Group (ECOG) physical status score <2 points, and American Association of Anesthesiologists (ASA) grade 1 to 3; (5) no mental illness; (6) able to answer questionnaires independently; (7) patients agreed to undergo laparoscopic distal gastrectomy and signed an informed consent. Exclusion criteria: (1) patients with severe chronic diseases and American Association of Anesthesiologists (ASA) grade >3; (2) patients with other malignant tumors; (3) patients suffered from serious mental diseases; (4) patients received neoadjuvant chemotherapy or immunotherapy. According to the above criteria, clinical data of 200 patients who underwent laparoscopic distal gastrectomy at the Department of General Surgery of the First Affiliated Hospital of Army Medical University from January 2016 to December 2019 were collected. Of the 200 patients, 108 underwent uncut Roux-en-Y anastomosis and 92 underwent Billroth II with Braun anastomosis. The general data, intraoperative and postoperative conditions, complications, and endoscopic evaluation 1 year after the surgery were compared. Besides, the quality of life of two groups was also compared using the Chinese version of the European Organization For Research and Treatment of Cancer (EORTC) quality of life questionnaire-Core 30 (QLQ-C30) and quality of life questionnaire-stomach 22 (QLQ-STO22). Results: There were no significant differences in baseline data between the two groups (all P>0.05). All the 200 patients successfully underwent laparoscopic distal gastrectomy without intraoperative complications, conversion to open surgery or perioperative death. There were no significant differences between two groups in operative time, intraoperative blood loss, postoperative complications, time to flatus, time to removal of gastric tube, time to liquid diet, time to removal of drainage tube or length of postoperative hospital stay (all P>0.05). Endoscopic evaluation was conducted 1 year after surgery. Compared to Billroth II with Braun group, the uncut Roux-en-Y group had a significantly lower incidences of gastric stasis [19.8% (17/86) vs. 37.0% (27/73), χ(2)=11.199, P=0.024], gastritis [11.6% (10/86) vs. 34.2% (25/73), χ(2)=20.892, P<0.001] and bile reflux [1.2% (1/86) vs. 28.8% (21/73), χ(2)=25.237, P<0.001], and the differences were statistically significant. The EORTC questionnaire was performed 1 year after surgery, there were no significant differences in the scores of QLQ-C30 scale between the two groups (all P>0.05), while the scores of QLQ-STO22 showed that, compared to the Billroth II with Braun group, the uncut Roux-en-Y group had a lower pain score (median: 8.3 vs. 16.7, Z=-2.342, P=0.019) and reflux score (median: 0 vs 5.6, Z=-2.284, P=0.022), and the differences were statistically significant (all P<0.05), indicating milder symptoms. Conclusion: The uncut Roux-en-Y anastomosis is safe and reliable in laparoscopic distal gastrectomy, which can reduce the incidences of gastric stasis, gastritis and bile reflux, and improve the quality of life of patients after surgery.

Adolescent , Adult , Aged , Humans , Middle Aged , Young Adult , Anastomosis, Roux-en-Y/adverse effects , Anastomosis, Surgical/adverse effects , Gastrectomy/methods , Gastroenterostomy/adverse effects , Laparoscopy/methods , Postoperative Complications/epidemiology , Quality of Life , Retrospective Studies , Stomach Neoplasms/pathology , Treatment Outcome
Rev. argent. cir ; 112(4): 459-468, dic. 2020. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1288158


RESUMEN ¿Se puede hablar de ciencia cuando nos referimos a la cirugía? No, de acuerdo con la epistemología clásica, que dice que para que una disciplina sea considerada científica debe alcanzar requisitos que la cirugía parecería no cumplir. Esto es, ser parte de un paradigma y crear conocimiento científico. Por lo que, si queremos afirmar la cientificidad de la cirugía, debemos investigar la existencia de ejem plares que podrían ser paradigmáticos, ya que son ellos los que fundamentan su estructura epistémi ca. Junto a esto debemos demostrar que su práctica crea conocimiento científico. Para ello, postulamos cinco objetivos que la cirugía debe cumplir. Además, a los personajes históricos clásicos a quienes se les atribuye haber fundado la cirugía moderna ‒Ambrosio Paré y John Hunter‒, solo pudieron alcanzar los tres primeros. Pero esto no basta para que se considere a la cirugía como parte de la ciencia. Debimos avanzar en la historia y encontrar esos ejemplares paradigmáticos. El primero corresponde al trabajo de investigación en fase animal, previa a la realización de la primera gastrectomía exitosa rea lizada en seres humanos por el cirujano alemán Theodor Billroth, en el año 1882. El segundo corres ponde a la investigación en fisiología tiroidea realizada por Emil T. Kocher, con la que ganó el premio Nobel en Medicina y Fisiología en año 1909. Se hace un análisis del desarrollo epistémico de la cirugía a partir de ellos y se evalúan las consecuen cias mediante el concepto de ciclo epistémico. Hipótesis clave para entender la creación del conoci miento científico a partir de disciplinas técnicas como la cirugía.

ABSTRACT Can we talk about science when we speak about surgery? Not, accordingly to classical epistemology. To consider a discipline as scientific, it must meet certain requirements that surgery would not seem to satisfy: being part of a paradigm and creating scientific knowledge. Therefore, if we want to affirm the scientific nature of surgery, we must investigate the existence of exemplars that could be paradigmatic, since they are the ones that support its epistemic structure. Along with this, we must demonstrate that their practice creates scientific knowledge. We've postulated five objectives that surgery had to satisfy. We've seen in classic history, that the main characters which are considered founders of modern surgery -Ambrosio Pare and John Hunter- were only able to reach the first three, and as we'll see, were not enough to consider surgery as part of science. Moving forward in history, we are able to find the first paradigmatic exemplars. The first corresponds to the research work in the animal phase, prior to the first successful human gastrectomy performed by the German surgeon Theodor Billroth, in 1882. The second corresponds to the research in thyroid's physiology carried out by Emil T. Kocher; thanks to this, he won the Nobel Prize in medicine and phy siology in 1909. An analysis of the epistemic development of surgery is made from them, and the consequences are analyzed using the concept of the epistemic cycle. Those key hypotheses are important to understand the creation of scientific knowledge in technical disciplines as surgery.

History, 18th Century , History, 19th Century , Philosophy, Medical , General Surgery/history , Science/history , Gastroenterostomy/history , Knowledge , History of Medicine
Rev. Assoc. Med. Bras. (1992) ; 66(11): 1521-1525, Nov. 2020. graf
Article in English | LILACS, SES-SP | ID: biblio-1143633


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.

Humans , Gastroenterostomy , Endosonography , Brazil , Stents , Gastric Outlet Obstruction/surgery , Gastric Outlet Obstruction/etiology , Gastric Outlet Obstruction/diagnostic imaging , Tertiary Care Centers
Rev. gastroenterol. Perú ; 39(2): 187-192, abr.-jun. 2019. ilus
Article in English | LILACS | ID: biblio-1058514


Anastomotic leakages at the gastrojejunostomy site are difficult to repair, due to complex gastrointestinal anatomy. This is the first study reporting clinical use of rectus abdominis muscle (RAM) flap for repair of gastrojejunostomy leakage. A patient with leakage of gastrojejunostomy after distal gastrectomy with Billrroth II anastomosis for gastric cancer underwent repair using left RAM flap, based on superior epigastric artery. Rectus abdominis muscle flap, after being harvested was then anchored to the edges of the leak of gastrojejunostomy with few interrupted 2-0 vicryl sutures. Gastrojejunostomy leak sealed in the two cases. Rectus abdominis muscle flap for closure of gastrointestinal defect is a simple, technically easy and dependable procedure, which can be performed, quickly in critically ill patients. It can be used for repair of a large gastrointestinal defect with friable edges when omentum is not available or when other conventional methods are impractical.

Las dehiscencias anastomóticas en el sitio de gastroyeyunostomía son difíciles de reparar, debido a la compleja anatomía gastrointestinal. Este es el primer estudio que comunica el uso clínico del colgajo del músculo recto abdominal (MRA) para la reparación de la dehiscencia de gastroyeyunostomía. A un paciente con dehiscencia de gastroyeyunostomía, luego de una gastrectomía distal con anastomosis Billrroth II para cáncer gástrico, se le realizó una reparación utilizando colgajo izquierdo del MRA, basado en la arteria epigástrica superior. El colgajo del músculo recto abdominal, después de ser extraído, se fijó a los bordes de la dehiscencia de la gastroyeyunostomía con pocas suturas de vicryl 2-0 interrumpidas. La dehiscencia de la gastroyeyunostomía fue sellada. El colgajo del músculo reto abdominal para el cierre del defecto gastrointestinal es un procedimiento simple, técnicamente fácil y confiable, que puede realizarse rápidamente en pacientes críticamente enfermos. Se puede utilizar para la reparación de un gran defecto gastrointestinal con bordes friables cuando el omento no está disponible o cuando otros métodos convencionales no son prácticos.

Female , Humans , Middle Aged , Stomach Neoplasms/surgery , Surgical Flaps , Gastric Bypass , Anastomotic Leak/surgery , Gastrectomy/methods , Digestive System Surgical Procedures/methods , Gastroenterostomy , Rectus Abdominis/transplantation
Article in Chinese | WPRIM | ID: wpr-774428


OBJECTIVE@#To evaluate the short-term efficacy and cosmetic effect of dual-port laparoscopic distal gastrectomy (DPLDG) for gastric cancer.@*METHODS@#Thirty consecutive patients underwent DPLDG at the Department of General Surgery, Nanfang Hospital from November 2016 to August 2018.@*INCLUSION CRITERIA@#(1) age of 18 to 75 years; (2) primary gastric adenocarcinoma confirmed pathologically by endoscopic biopsy; (3) tumor located at middle-low stomach and planned for distal gastrectomy; (4) cT1b-2N0-1M0 at preoperative staging; (5) tumor diameter ≤3 cm; (6) US Eastern Cancer Cooperative Group(ECOG) score 0 to 1 points; (7) American Society of Anesthesiologists grade I to II; (8) perioperative management based on enhanced recovery after surgery (ERAS) principle.@*EXCLUSION CRITERIA@#previous upper abdominal surgery (except laparoscopic cholecystectomy), history of other malignant disease, and body mass index ≥30 kg/m². A self-developed single-incision, multiport, laparoscopic surgery Trocar (Surgaid Medical, Xiamen, China, comprising 3 channels for observation, main surgeon and assistant surgeon) was placed through a 3-4 cm incision under or at the left side of the umbilicus. An additional 5 mm Trocar was inserted under the rib margin of the right clavicle to serve as the secondary operating hole and the position of the drainage tube. The liver was suspended to expose the surgical field clearly. Surgical procedure was as follows: conventional laparoscopic instruments were used. After entering the omental sac, dissection was performed along the transverse colon to the spleen flexure. Left gastroepiploic vessels were identified and then ligated at the root. No.4sb lymph nodes were dissected. The No.4d lymph nodes were dissected along the greater curvature of the stomach. Then the dissection was continued rightward to the hepatic flexure to separate mesogastrium and mesocolon. The right gastroepiploic artery was ligated at the root to allow the removal of No.6 lymph nodes. The duodenal bulb was transacted by liner stapler, the right gastric artery was ligated at the root and the No.5 lymph nodes were removed. Peritoneal trunk, common hepatic artery, splenic artery and left gastric artery and vein in posterior pancreatic space at upper pancreas were separated, then left gastric vessels were ligated, and No.9, No.8a, No.11p and No.7 lymph nodes were dissected. The left side wall of portal vein was exposed and No.12a lymph nodes were removed. No.1 and No.3 lymph nodes were dissected along the lesser curvature. The stomach corpus was transacted by liner stapler at 4-5 cm proximal end of the tumor. Roux-en-Y anastomosis or Billroth II anastomosis was performed in the cavity. A drainage tube was placed near the gastrojejunal anastomosis through the right upper abdomen secondary operating hole. Postoperative short-term efficacy (operation time, blood loss, 5-port conversion rate, open conversion rate, number of retrieved lymph nodes, time to postoperative first flatus, time to first soft diet intake, time to removal of drainage tube, postoperative hospital stay, postoperative analgesics use, and postoperative 30-day complication rate) and cosmetic scale (questionnaire: degree of satisfaction with scar, description of scar, grade of scar; total score ranged from the lowest 3 to the highest 24; the higher the better) were evaluated in all 30 patients.@*RESULTS@#No serious complication and death were observed intraoperatively. The mean operative time was (197.8±46.9) minutes. The median blood loss was 30 ml (quartile 31.25 ml). The mean number of retrieved lymph node was 38.7±14.1. Five-port conversion rate was 3.3% (1/30), and no open conversion occurred. Mean time to postoperative first flatus, time to first soft diet intake, time to removal of drainage tube and postoperative hospital stay were (45.3±18.9) hours, (87.6±35.6) hours, (101.8±58.0) hours and (6.1±2.1) days, respectively. Twenty-four (80%) of patients had no additional analgesics use. The postoperative complication rate within 30 days was 16.7% (5/30). Postoperative overall cosmetic score was 22.1±1.3, and cosmetic score of 96.7%(29/30) of patients was 18 to 24.@*CONCLUSION@#DPLDG is safe and feasible with advantages of faster postoperative recovery, reducing pain and better cosmetic outcomes.

Humans , Adenocarcinoma , Pathology , General Surgery , China , Feasibility Studies , Gastrectomy , Methods , Gastroenterostomy , Laparoscopy , Methods , Lymph Node Excision , Retrospective Studies , Stomach Neoplasms , Pathology , General Surgery , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-774394


OBJECTIVE@#To compare the safety of Billroth I and Billroth II reconstruction in distal gastrectomy for gastric cancer and short-term endoscopic findings.@*METHODS@#A retrospective cohort study was carried out. Clinical data of gastric adenocarcinoma patients who received distal subtotal gastrectomy with Billroth I or Billroth II reconstruction at Department 4 of Gastrointestinal Surgery, Peking University Cancer Hospital from January 2013 to July 2017 were collected retrospectively. Patients with stage IV gastric cancer, emergent operation, preoperative chemotherapy, combined organ resection and other malignancies were excluded. A total of 277 patients were enrolled in the study with 143 patients in the Billroth I group and 134 patients in the Billroth II group. The intra-operative conditions, postoperative early recovery, postoperative complications, and postoperative 1-year endoscopic findings were compared between the two groups. The normal distribution variables were analyzed by t test; the non-normal distribution variables were analyzed by Mann-Whitney U test; sort variables were compared between groups using the χ² test or Fisher's exact test.@*RESULTS@#In the Billroth I group, 93 (65.0%) cases were male, mean age was (58.1±10.9) years and body mass index was (23.3±3.2) kg/m. In the Billroth II group, 94 (70.1%) cases were male, mean age was (58.3±9.5) years and body mass index was (23.7±2.9) kg/m. There were no significant differences in baseline data between in the two groups (all P>0.05). As compared to the Billroth I group, the Billroth II group had significantly longer operation time [mean (230.7±44.6) minutes vs. (210.3±41.4) minutes, t=3.935, P0.05). In the Billroth I group, 1 case developed anastomotic bleeding, 3 cases anastomotic leakage, 4 cases emptying disorder, 4 cases peritoneal cavity infection, and all of them healed after conservative treatment. In the Billroth II group, 1 case developed anastomotic bleeding, 1 case peritoneal cavity bleeding, 3 cases emptying disorder, 3 cases peritoneal cavity infection, and all of them healed after conservative treatment, while 1 case developed postoperative duodenal stump leakage and underwent a second operation. Morbidity of postoperative complication was 8.4% (12/143) and 6.7% (9/134) in the Billroth I group and Billroth II group respectively (χ²=0.277, P=0.599) without statistically significant difference. Postoperative one-year endoscopy was performed in 78 cases of the Billroth I group and 57 cases of the Billroth II group. Endoscopic findings revealed that ratio of food retention [21.8% (17/78) vs. 33.3% (19/57), χ²= 2.242, P=0.134], ratio of residual gastritis [48.7% (38/78) vs. 47.4% (27/57), χ²=0.024, P=0.877] and incidence of bile reflux [12.8% (10/78) vs. 10.5% (6/57), χ²=0.166, P=0.684] were not significantly different between two groups.@*CONCLUSIONS@#For distal gastrectomy, Billroth I reconstruction is easier to operate, while Billroth II reconstruction presents faster recovery of gastrointestinal function and shorter hospital stay. The morbidity of postoperative complication and short-term endoscopic findings between two groups are comparable.

Aged , Female , Humans , Male , Middle Aged , Gastrectomy , Gastroenterostomy , Postoperative Complications , Retrospective Studies , Stomach Neoplasms , General Surgery
Article in Korean | WPRIM | ID: wpr-786345


Endoscopic papillary balloon dilation (EPBD) and endoscopic papillary large balloon dilation (EPLBD) have been performed all around the world over several decades for the treatment of common bile duct stone. EPBD using small dilation balloon catheter can preserve sphincter of Oddi function and reduce the recurrence rate of bile duct stone compared to endoscopic sphincterotomy (EST). EPBD is a procedure with low risk of bleeding, which is appropriate for patients with coagulopathy, hepatic cirrhosis, end-stage of renal disease, and surgically altered anatomy such as Billroth II gastrectomy and periampullary diverticulum. However, it has a higher risk of postprocedure pancreatitis than EST. EPLBD using large balloon catheter (12 mm or more of diameter) is proper for more than 10 mm of common bile duct stone. The advantages of EPLBD are reduced need for mechanical lithotripsy with decreased procedure time and radiation exposure time irrespective of the precedence of EST. EPLBD also requires fewer endoscopic retrograde cholangiopancreatography sessions and is more cost-effective. The incidence of post-procedure pancreatitis is lower in EPLBD than EST. If EPBD and EPLBD are done under the guidelines, these would be safe and effective and may be alternatives to EST for common bile duct stone.

Humans , Bile Ducts , Catheters , Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis , Common Bile Duct , Diverticulum , Gastrectomy , Gastroenterostomy , Hemorrhage , Incidence , Lithotripsy , Liver Cirrhosis , Pancreatitis , Radiation Exposure , Recurrence , Sphincter of Oddi , Sphincterotomy, Endoscopic
Journal of Gastric Cancer ; : 438-450, 2019.
Article in English | WPRIM | ID: wpr-785958


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.

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 Neoplasms
Journal of Gastric Cancer ; : 111-120, 2019.
Article in English | WPRIM | ID: wpr-740305


BACKGROUND: Billroth I anastomosis is one of the most common reconstruction methods after distal gastrectomy for gastric cancer. Intracorporeal Billroth I (ICBI) anastomosis and extracorporeal Billroth I (ECBI) anastomosis are widely used in laparoscopic surgery. Here we compared ICBI and ECBI outcomes at a major gastric cancer center. METHODS: We retrospectively analyzed data from 2,284 gastric cancer patients who underwent laparoscopic distal gastrectomy between 2009 and 2017. We divided the subjects into ECBI (n=1,681) and ICBI (n=603) groups, compared the patients’ clinical characteristics and surgical and short-term outcomes, and performed risk factor analyses of postoperative complication development. RESULTS: The ICBI group experienced shorter operation times, less blood loss, and shorter hospital stays than the ECBI group. There were no clinically significant intergroup differences in diet initiation. Changes in white blood cell counts and C-reactive protein levels were similar between groups. Grade II–IV surgical complication rates were 2.7% and 4.0% in the ECBI and ICBI groups, respectively, with no significant intergroup differences. Male sex and a body mass index (BMI) ≥30 were independent risk factors for surgical complication development. In the ECBI group, patients with a BMI ≥30 experienced a significantly higher surgical complication rate than those with a lower BMI, while no such difference was observed in the ICBI group. CONCLUSION: The surgical safety of ICBI was similar to that of ECBI. Although the chosen anastomotic technique was not a risk factor for surgical complications, ECBI was more vulnerable to surgical complications than ICBI in patients with a high BMI (≥30).

Humans , Male , Body Mass Index , C-Reactive Protein , Diet , Gastrectomy , Gastroenterostomy , Intraoperative Complications , Laparoscopy , Length of Stay , Leukocyte Count , Postoperative Complications , Retrospective Studies , Risk Factors , Stomach Neoplasms
Acta cir. bras ; 34(3): e201900308, 2019. tab, graf
Article in English | LILACS | ID: biblio-989065


Abstract Purpose: To create a checklist to evaluate the performance and systematize the gastroenterostomy simulated training. Methods: Experimental longitudinal study of a quantitative character. The sample consisted of twelve general surgery residents. The training was divided into 5 sessions and consisted of participation in 20 gastroenterostomys in synthetic organs. The training was accompanied by an experienced surgeon who was responsible for the feedback and the anastomoses evaluation. The anastomoses evaluated were the first, fourth, sixth, eighth and tenth. A 10 item checklist and the time to evaluate performance were used. 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 0,295 showed a high linear correlation between time variables and Checklist. The average Checklist score went from 6.8 to 9 points. Conclusion: The proposed checklist can be used to evaluate the performance and systematization of a simulated training aimed at configuring a gastroenterostomy.

Humans , Gastroenterostomy/education , Checklist , Simulation Training/methods , Internship and Residency , Longitudinal Studies , Clinical Competence , Models, Anatomic
Rev. gastroenterol. Perú ; 38(4): 384-387, oct.-dic. 2018. ilus
Article in English | LILACS | ID: biblio-1014115


Endoscopic retrograde cholangiopancreatography (ERCP) is the treatment of choice in patients with choledocholithiasis. However, despite its high success rate, in some cases it is not successful, requiring alternative therapy. Billroth II partial gastrectomy is a condition associated with an important failure rate of ERCP. When endoscopic treatment fails, surgical exploration of the bile duct is the most common approach. However, the surgery is related to a greater complexity of execution and morbimortality. We describe the case of a patient with choledocholithiasis and Billroth II partial gastrectomy, submitted to the combined treatment called rendez-vous laparoendoscopic, after failure of ERCP, which unites in a single stage the endoscopic treatment of choledocholithiasis and laparoscopic removal of the gallbladder. We conclude that this therapeutic approach was effective, safe, with low cost and without complications.

La colangiopancreatografía endoscópica retrógrada (CPRE) es el tratamiento de elección en pacientes portadores de coledocolitiasis. Sin embargo, a pesar de su elevada tasa de éxito, en algunos casos no es exitosa, exigiendo terapia alternativa. La gastrectomía parcial con reconstrucción a Billroth II es una condición asociada a la importante tasa de fracaso de la CPRE. Cuando el tratamiento endoscópico falla, la exploración quirúrgica de la vía biliar es un enfoque más común. Sin embargo, la cirugía se relaciona con una mayor complejidad de ejecución y morbimortalidad. Describimos el caso de un paciente con coledocolitiasis y gastrectomía parcial con reconstrucción a Billroth II, sometido al tratamiento combinado denominado rendez-vous laparoendoscópico tras fallo de la CPRE, que une en una sola etapa el tratamiento endoscópico de la coledocolitiasis y la retirada laparoscópica de la vesícula biliar. Llegamos a la conclusión de que este enfoque terapéutico fue eficaz, seguro, de bajo costo y sin complicaciones.

Humans , Male , Middle Aged , Gastroenterostomy , Cholangiopancreatography, Endoscopic Retrograde , Laparoscopy , Choledocholithiasis/surgery , Gastrectomy/methods , Treatment Failure
Article in English | WPRIM | ID: wpr-713267


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. The patient remained well after the exposed Hem-o-Lok clip was identified. A third EGD 6 months later showed that the clip had disappeared from the anastomosis site, and that this site was covered with normal mucosa surrounding the scar.

Humans , Middle Aged , Cicatrix , Endoscopy, Digestive System , Foreign-Body Migration , Gastrectomy , Gastroenterostomy , Inflammation , Mucous Membrane , Postoperative Complications , Stomach Neoplasms , Surgical Instruments
Article in Chinese | WPRIM | ID: wpr-691293


Methods of digestive tract reconstruction after distal gastrectomy include Billroth I, Billroth II and Roux-en-Y. Each of them has advantages and disadvantages respectively. Alkaline reflux gastritis (ARG) is one of the complications after distal gastrectomy, which is common after Billroth II. In the past 100 years, the ways of digestive tract reconstruction have been continuously improved and developed to prevent the occurrence of alkaline reflux gastritis, and Roux-en-Y is one of them. Still, there is a high incidence of Roux stasis syndrome resulting from Roux-en-Y, with impact on quality of life. Therefore, the appropriate reconstruction is needed urgently. Braun anastomosis was proposed in 1892 to lower the incidence of afferent syndrome. Because of its effect of diverting some alkaline digestive juice, it was applied to pancreaticoduodenectomy and distal gastrectomy. Some studies have proved its effect of diverting some alkaline digestive juice, but the diverted quantity was rarely shown. Besides, compared with Roux-en-Y, Billroth II with Braun anastomosis is safer and more convenient. Meantime it is likely to have benefits in aspect of preventing anemia and malnutrition. In order to provide evidence to clinical practice, this article summarizes the history and research advance of Billroth II with Braun anastomosis by reviewing previous reports.

Humans , Anastomosis, Roux-en-Y , Anastomosis, Surgical , Gastrectomy , Methods , Gastroenterostomy , Methods , Quality of Life , Stomach Neoplasms , General Surgery
Article in Chinese | WPRIM | ID: wpr-689668


<p><b>OBJECTIVE</b>To compare the short-term safety and costs between laparoscopic assisted or totally laparoscopic uncut Roux-en-Y and Billroth II((BII() + Braun reconstruction after radical gastrectomy of distal gastric cancer.</p><p><b>METHODS</b>Clinical data from our prospective database of radical gastrectomy were systematically analyzed. The patients who underwent laparoscopic gastrectomy with uncut Roux-en-Y or BII(+ Braun reconstruction between March 1st, 2015 and June 30th, 2017 were screened out for further analysis. Both the reconstructions were completed by linear staplers. Uncut Roux-en-Y reconstruction was performed with a 45 mm no-knife linear stapler (ATS45NK) on the afferent loop below the gastrojejunostomy. Continuous variables were compared using independent samples t test or Mann-Whitney U. The frequencies of categorical variables were compared using Chi-squared or Fisher exact test.</p><p><b>RESULTS</b>Eighty-one patients were in uncut Roux-en-Y group and 58 patients were in BII(+Braun group. There were no significant differences between uncut Roux-en-Y group and BII(+Braun group in median age (56.0 years vs. 56.5 years, P=0.757), gender (male/female, 52/29 vs. 46/12, P=0.054), history of abdominal surgery (yes/no, 10/71 vs. 4/54, P=0.293), neoadjuvant chemotherapy (yes/no, 21/60 vs. 11/47, P=0.336), BMI (thin/normal/overweight/obesity, 2/49/26/3 vs. 3/39/14/2, P=0.591), NRS 2002 score (1/2/3/4, 58/15/5/3 vs. 47/5/3/3, P=0.403), pathological stage (0/I(/II(/III(, 3/41/20/17 vs. 1/28/13/16, P=0.755), median tumor diameter in long axis (2.5 cm vs. 3.0 cm, P=0.278), median tumor diameter in short axis (2.0 cm vs. 2.0 cm, P=0.126) and some other clinical and pathological characteristics. There were no significant differences between uncut Roux-en-Y group and BII(+Braun group in morbidity of postoperative complication more severe than grade I([12.3% (10/81) vs. 17.2% (10/58), P=0.417], morbidity of anastomotic complication [1.2%(1/81) vs. 0, P=1.000] or hospitalization costs [(94000±14000) yuan vs.(95000±16000) yuan, P=0.895]. The median first time to liquid diet (57.1 hours vs. 70.8 hours, P=0.017) and median postoperative hospital stay (9 days vs. 11 days, P=0.003) of the patients in uncut Roux-en-Y group were shorter than those in BII(+Braun group.</p><p><b>CONCLUSION</b>Laparoscopic assisted or totally laparoscopic uncut Roux-en-Y reconstruction after radical gastrectomy of distal gastric cancer is safe and feasible with better recovery than BII(+Braun reconstruction.</p>

Female , Humans , Male , Middle Aged , Anastomosis, Roux-en-Y , Databases, Factual , Gastrectomy , Gastroenterostomy , Laparoscopy , Methods , Prospective Studies , Stomach Neoplasms , General Surgery , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-689660


Gastric stump cancer was initially defined as a carcinoma of the stomach occurring more than 5 years after surgery for gastric or duodenal benign disease. In recent years, as the number of total gastrectomy for benign disease has gradually decreased and the gastric cancer detection and operation rate have annually increased, residual recurrence of primary gastric cancer more than 10 years after gastric cancer surgery has also been considered as gastric stump cancer. The incidence of gastric stump cancer is increasing annually. The epidemiological characteristics of this form of cancer are also developing, and they show a higher incidence in males compared to females. The incidence has been affected following digestive tract reconstruction, and the risk increases in patients who undergo Billroth II( reconstruction. The interval of onset is related to the benign and malignant condition of primary disease, and the incidence increases after 10 years of early gastric cancer surgery. Lymph node metastasis pattern in gastric stump cancer is different from that in primary gastric cancer as the primary operation may destroy normal lymph flow. Many factors are known to cause gastric stump cancer, mainly duodenal gastric reflux, Helicobacter pylori infection, and gastric mucosal barrier dysfunction; however, the mechanism is not clear. It is expected to reduce the incidence of gastric stump cancer by taking precautionary measures against different inducements, which also has some guiding significance for the treatment and prognosis of gastric cancer.

Female , Humans , Male , Gastrectomy , Gastric Stump , Pathology , General Surgery , Gastroenterostomy , Incidence , Neoplasm Recurrence, Local , Risk Factors , Stomach Neoplasms , Epidemiology , General Surgery
ABCD arq. bras. cir. dig ; 30(4): 267-271, Oct.-Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-885742


ABSTRACT Introduction: Single anastomosis gastric bypass (one anastomosis gastric bypass or mini-gastric bypass) has been presented as an option of surgical treatment for obese patients in order to reduce operation time and avoiding eventual postoperative complications after Roux-en-Y gastric bypass.The main late complication could be related to bile reflux. Aim: To report the experiences published after Billroth II anastomosis and its adverse effects regarding symptoms and damage on the gastric and esophageal mucosa . Method: For data recollection Medline, Pubmed, Scielo and Cochrane database were accessed, giving a total of 168 papers being chosen 57 of them. Results: According the reported results during open era surgery for peptic disease and more recent results for gastric cancer surgery, bile reflux and its consequences are more frequent after Billroth II operation compared to Roux-en-Y gastrojejunal anastomosis. Conclusion: These findings must be considered for the indication of bariatric surgery.

RESUMO Introdução: Bypass com anastomose única ou mini-bypass gástrico foi apresentado como oopção de tratamento cirúrgico para pacientes obesos, a fim de reduzir o tempo da operação e evitar complicações pós-operatórias após bypass gástrico Y-de-Roux. A principal complicação tardia pode estar relacionada ao refluxo biliar. Objetivo: Relatar as experiências publicadas após a anastomose Billroth II e seus efeitos adversos em relação aos sintomas e danos sobre a mucosa gástrica e esofágica. Método: A coleta de dados foi baseada na busca nas bases Medline, Pubmed, Scielo e Cochrane. Um total de 168 artigos foram revisados, tendo sido escolhidos 57 deles. Resultados: De acordo com os resultados relatados durante a operação da era aberta para doença péptica e resultados mais recentes para o tratamento cirúrgico do câncer gástrico, o refluxo biliar e suas consequências são mais frequentes após o Billroth II em comparação com a anastomose gastrojejunal em Y-de-Roux. Conclusão: Esses achados devem ser considerados para a indicação de cirurgia bariátrica.

Humans , Gastric Bypass/methods , Obesity/surgery , Gastroenterostomy , Forecasting
Rev. gastroenterol. Perú ; 37(4): 379-386, oct.-dic. 2017. ilus
Article in Spanish | LILACS | ID: biblio-991284


La presente comunicación, describe el primer caso en el Instituto Regional de Enfermedades Neoplásicas "Luis Pinillos Ganoza" IREN Norte en la que una paciente con carcinoma gástrico avanzado ha mostrado respuesta histopatológica completa a neoadyuvancia. Se presenta una paciente mujer de 70 años con diagnóstico histopatológico de adenocarcinoma gástrico tubular moderadamente diferenciado, localmente avanzado con imágenes de adenopatías perigástricas asociadas y pérdida de la interfase entre tumoración gástrica, hilio hepático y vesícula biliar. Luego de 6 cursos de quimioterapia neoadyuvante con esquema FOLFOX - 4 al 80%, se obtiene una respuesta casi completa desde el punto de vista tomográfico; por ello a la paciente se le realiza gastrectomía subtotal distal más linfadenectomía D2 más gastroyeyunoanastomosis Billroth II término lateral tipo Hofmeister Finsterer, verificándose, al examen microscópico de la pieza operatoria, sólo gastritis crónica y aguda con áreas mucosas y cambios reactivos. No se observa neoplasia maligna viable. Ganglios linfáticos: 0/33. Paciente evoluciona favorablemente. A propósito del caso se hace una revisión de la literatura médica relevante actualizada

This communication describes the first case in the Regional Institute of Neoplastic Diseases "Luis Pinillos Ganoza" IREN North in which a patient with advanced gastric carcinoma showed complete response to neoadjuvant histopathologic. We describe the case of a patient woman of 70 years old with histopathologic diagnosis of moderately differentiated tubular gastric adenocarcinoma, locally advanced associated with images of perigastric lymphadenopathy and loss of the interface between gastric tumor, hepatic hilum and gallbladder. After 6 courses of neoadjuvant chemotherapy with FOLFOX scheme - 4 to 80%, an almost complete response from the point of tomographic view is obtained, so the patient is underwent to distal subtotal gastrectomy lymphadenectomy D2 more gastrojejunoanastomosis Billroth II termino lateral type Hofmeister Finsterer verifying on microscopic examination of surgical specimen only acute and chronic gastritis with mucous areas and reactive changes. No feasible malignancy is observed. Lymph nodes: 0/33. Commenting on the case, a review of recent relevant literature is realized

Aged , Female , Humans , Stomach Neoplasms/drug therapy , Adenocarcinoma/drug therapy , Neoadjuvant Therapy , Organoplatinum Compounds/administration & dosage , Stomach Neoplasms/surgery , Stomach Neoplasms/pathology , Biopsy , Remission Induction , Gastroenterostomy , Adenocarcinoma/surgery , Adenocarcinoma/pathology , Adenocarcinoma/secondary , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Leucovorin/administration & dosage , Combined Modality Therapy , Fluorouracil/administration & dosage , Gastrectomy/methods , Lymph Node Excision , Lymphatic Metastasis , Neoplasm Invasiveness
GED gastroenterol. endosc. dig ; 36(2): 58-59, Abr.-Jun. 2017. ilus
Article in Portuguese | LILACS | ID: biblio-876740


Apresenta-se o caso de um homem, 57 anos, submetido a uma antrectomia com reconstrução a Billroth II devido a uma úlcera péptica sangrante, que evoluiu no quarto dia de pós-operatório com intuscepção anterógrada jejuno-jejunal, causando síndrome da alça aferente.

Its reported a case of a 57-year-old male, who underwent an antrectomy with Billroth II reconstruction because of an bleeding peptic ulcer, that evolved in the fourth day postoperatively with a anterograde jejunojejunal intussusception causing afferent loop syndrome.

Humans , Male , Middle Aged , Gastroenterostomy , Gastroenterostomy/adverse effects , Afferent Loop Syndrome , Gastrectomy , Intussusception
Acta cir. bras ; 32(1): 81-89, Jan. 2017. graf
Article in English | LILACS | ID: biblio-837667


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.

Humans , Male , Female , Adult , General Surgery/education , Gastroenterostomy/education , Laparoscopy/education , Simulation Training/methods , Internship and Residency , Longitudinal Studies , Models, Anatomic
Article in Chinese | WPRIM | ID: wpr-303907


<p><b>OBJECTIVE</b>To evaluate the feasibility and safety of the delta-shaped anastomosis in laparoscopic distal gastrectomy and digestive tract reconstruction.</p><p><b>METHODS</b>Clinical data of 34 gastric cancer patients undergoing laparoscopic distal gastrectomy with the delta-shaped anastomosis for digestive tract reconstruction (delta-shaped group) and 83 gastric cancer patients undergoing laparoscopic distal gastrectomy with Billroth I( for digestive tract reconstruction (Billroth group) by same surgeon team from July 2013 to July 2015 at the Department of Digestive Surgery, Affiliated Tumor Hospital of Shanxi Medical University were retrospectively analyzed. Data of two groups were compared.</p><p><b>RESULT</b>Age, gender, tumor stage were not significantly different between the two groups(all P>0.05). Operation time of the first 15 cases in delta-shaped group was longer than that in Billroth group [(254.7±35.4) min vs. (177.8±33.0) min, t=11.190, P=0.000], while after above 15 cases, the operation time of delta-shaped group was significantly shorter than that of Billroth group [(142.1±14.6) min vs. (177.8±33.0) min, t=-4.109, P=0.001]. Delta-shaped group had less blood loss during operation [(87.1±36.7) ml vs. (194.0±55.1) ml, t=-10.268, P=0.000], and shorter length of incision [(4.1±0.4) cm vs. (6.1±1.0) cm, t=-10.331, P=0.000] than Billroth group. Compared with Billroth group, delta-shaped group presented faster postoperative bowel function return [(2.8±0.6) d vs. (3.3±0.5) d, t=-3.755, P=0.000], earlier liquid food intake [(7.4±1.5) d vs. (8.1±1.7) d, t=-4.135, P=0.000], earlier ambulation [(4.0±1.6) d vs. (6.8±1.4) d, t=-7.197, P=0.000] and shorter postoperative hospital stay [(12.6±1.9) d vs.(13.6±2.0) d, t=-20.149, P=0.000]. Morbidity of postoperative complication was 5.9%(2/34) in delta-shaped group, including anastomotic fistula in 1 case and incision infection in 1 case, and 6.0%(5/83) in Billroth group, including anastomotic fistula, incision infection, anastomotic stricture and dumping syndrome, without significant difference(P>0.05). Difference value of total protein and albumin between pre-operation and post-operation, and average decreased value of total protein, albumin, body weight between pre-operation and postoperative 6-month were not significantly different between two groups(all P>0.05). As for patients with BMI > 25 kg/m, compared to Billroth group, delta-shaped group presented less blood loss during operation [(94.1±36.7) ml vs. (203.0±55.1) ml, t=-10.268, P=0.000], lower injective dosage of postoperative analgesics [(1.9±1.1) ampule vs.(3.3±2.0) ampule, t=-2.188, P=0.032], faster intestinal recovery [(2.9±0.7) d vs. (3.2±0.9) d, t=-3.755, P=0.009], shorter hospital stay [(10.5±1.2) d vs. (11.7±1.5) d, t=-2.026, P=0.004], and lower morbidity of postoperative complication [7.1%(1/14) vs. 13.6%(3/22), χ=4.066, P=0.031].</p><p><b>CONCLUSION</b>In laparoscopic distal gastrectomy and digestive tract reconstruction, the delta-shaped anastomosis is safe and feasible, especially suitable for obese patients.</p>

Female , Humans , Male , Anastomosis, Surgical , Methods , Blood Loss, Surgical , Comparative Effectiveness Research , Constriction, Pathologic , Epidemiology , Defecation , Digestive System Fistula , Epidemiology , Drinking , Dumping Syndrome , Epidemiology , Gastrectomy , Methods , Gastroenterostomy , Methods , Laparoscopy , Methods , Length of Stay , Operative Time , Postoperative Complications , Epidemiology , Postoperative Period , Recovery of Function , Retrospective Studies , Stomach Neoplasms , General Surgery , Surgical Wound , Surgical Wound Infection , Epidemiology , Treatment Outcome