Significance of intraoperative endoscopy in total gastrectomy for gastric cancer.

BACKGROUND: Anastomotic impairment can be a major cause of surgical complications in gastrointestinal surgery. The aim of this study was to evaluate the efficacy of intraoperative endoscopy (IOE) in esophagojejunal anastomosis for detection of anastomotic impairment. METHODS: Forty-eight patients who underwent total gastrectomy were evaluated for the integrity of the esophagojejunostomy using IOE at completion of mechanical esophagojejunal anastomosis. RESULTS: Overall postoperative anastomotic leakage (PAL) rate was 4.2% (n = 2/48). Both patients who developed PAL had abnormal findings such as mucosal defect in the esophageal mucosa or incomplete anastomotic stapling. Also, IOE revealed inadvertent anastomotic failure in three patients: two jejunal and one esophageal occlusion. There were no complications due to IOE. CONCLUSION: IOE is safe and may easily provide significant information that can minimize PAL by detecting anastomotic failure on esophagojejunal anastomosis.

How can we control intraoperative bacterial contamination and surgical-site infection during an anterior resection or Hartmann's/Miles' operation?

PURPOSE: Intraoperative bacterial contamination (IBC) is a major cause of surgical-site infection (SSI). Therefore, we investigated whether the ingenuity of surgical procedures could reduce the incidence of IBC/SSI. METHODS: Sixty patients who were surgically treated for recto-sigmoid cancer were investigated. Among these patients, the colon was transected during the early perioperative period (ET) in 29 patients and during the late period (LT) in 31 patients. Three samples for IBC were obtained from the irrigation fluid before abdominal closure (LAVAGE), the remaining cut sutures after peritoneal closure (SUTURE), and a subcutaneous swab of the wound (SUBCUT). RESULTS: The overall SSI and IBC rates were 25% and 55.2%, respectively. Patients who developed SSI had an extremely high IBC rate (85%), and IBC patients also had a high SSI rate (68%). IBC was highest in the LAVAGE (26%) followed by the SUBCUT (26%), and the SUTURE (12%). The incidence of IBC in the LT was significantly lower than that in the ET (19% vs. 55%, p < 0.01), although the incidence of SSI was similar in both IBC groups. CONCLUSION: Shortening the exposure of the colonic mucosa decreased the incidence of IBC/SSI; thus, careful operations to minimize IBC are recommended.

Intraoperative thermal imaging in esophageal replacement: its use in the assessment of gastric tube viability.

We examined the use of intraoperative thermal imaging to assess the gastric vascularization and gastric tube viability during esophagectomy. The surface temperatures of the intact stomach, devascularized stomach, and gastric tube were measured in 13 patients from the proximal end to the pylorus longitudinally along the greater curvature or along the entire gastric tube during esophagectomy. Thermal images clearly demonstrated a surface temperature decline in the proximal region of the gastric tube. The mean decline rate in the surface temperature in the proximal region of the gastric tube in comparison to the intact stomach was 17.7% (P < 0.001). One patient who developed gastric tube necrosis exhibited a prominent drop in the surface temperature in the proximal region of 20.6% in comparison to that in the distal region, compared to that of 12.5% in other patients. Intraoperative thermal imaging is a noninvasive and reliable technique for the assessment of the gastric tube viability.