Totally mechanical linear stapled anastomosis for minimally invasive Ivor Lewis esophagectomy: Operative technique and short-term outcomes.

BACKGROUND: Anastomosis is one of the important factors affecting anastomotic complications after esophagectomy, and multiple reports have compared anastomotic complications among various techniques. However, there is insufficient evidence in the literature to definitively recommend one anastomotic technique over another. METHOD: We retrospectively evaluated 34 consecutive patients who underwent an improved totally mechanical side-to-side: posterior-to-posterior linear stapled (TM-STS) technique for minimally invasive Ivor Lewis esophagogastric anastomosis, performed by a single surgeon between February 2015 to November 2017. The operative techniques and short-term outcomes are analyzed in this study. RESULTS: There were no conversions to an open approach and a complete resection was achieved in all patients undergoing this improved procedure. During the first half of the series, the median operation time was 355 minutes, ranging from 257 to 480 minutes. Over the second half of this series, the median operation time was reduced to 256 minutes. There were no mortalities or serious postoperative complications. Only one patient (2.9%) had an anastomotic leak, which resolved without intervention. Another patient (2.9%) experienced transient, delayed conduit emptying which upper gastrointestinal radiography determined was due to a mechanical obstruction caused by an abnormally long gastric tube in the chest cavity. CONCLUSIONS: The results of our study suggest that this improved TM-STS technique is safe and effective for minimally invasive Ivor Lewis esophagectomy, and can be considered as one of the alternative procedure for patients with lower esophageal as well as Siewert types I/II gastroesophageal junction carcinoma.

[Clinical study on risk factor associated with gut flora change in patients with rectal cancer during perioperative period].

OBJECTIVE: To investigate the effects of the different treatment on gut flora in patients with rectal cancer in the perioperative period. METHODS: A total of 64 patients with rectal cancer were prospectively enrolled from July 2010 to June 2011 at the Qingdao University Medical College Affiliated Hospital, and randomized into 8 groups receiving different treatments in perioperative period. Factorial design was used to study three factors including preoperative bowel preparation, antibiotics use, and postoperative fasting. Patients were randomized into 8 groups with 8 patients in each group using the random digit table. Preoperative and postoperative stool specimens were collected and diluted, which were transferred to selective medium. Bacteria counts were calculated after 48 hours of culture under constant temperature. The changes in gut flora between the different groups were compared. RESULTS: Compared to the preoperative parameters, total bacteria, Bifidobacterium, Peptostreptococcus, Lactobacillus, Bacteroides, Enterococcus decreased significantly(P<0.05), while the E.coli count increased significantly. The bacillus/coccus ratio was significantly imbalanced. Preoperative bowel preparation, oral antibiotics, and postoperative fasting were all predominant factors associated with gut flora(all P<0.05). Compared with the antibiotic restriction group, Bacteroides, Enterococcus, Lactobacillus, Peptostreptococcus, and total bacteria count were reduced significantly, and the bacillus/coccus ratio increased in the non-antibiotics restriction group(P<0.05). In the bowel preparation group, Bacteroides, Peptostreptococcus, total bacteria count, and the bacillus/coccus ratio decreased(P<0.05). In the postoperative fasting group, Bacteroides, Enterococcus, total bacteria, and bacillus/coccus ratio decreased(P<0.05). CONCLUSIONS: Antibiotics, bowel preparation, and postoperative fasting can affect the number and ratio of gut flora in patients with rectal cancer in the perioperative period, leading to dysbacteriosis.

[Effect of different perioperative treatments on gut flora in SD rats].

OBJECTIVE: To study the effects of different perioperative treatments on the number and proportion of gut flora in SD rats. METHODS: Forty-eight SD rats were randomized into 8 groups including the control group, antibiotics group, bowel preparation group, fasting group, antibiotic-bowel preparation group, antibiotics-bowel preparation-fasting group, bowel preparation-surgery-antibiotics-early postoperative feeding group (early feeding group), and bowel preparation-surgery-antibiotics-postoperative fasting group. The rats were sacrificed and stool specimens were collected from the cecum. Stools were diluted and transferred to selective medium. Bacteria counts were calculated after 48 hours of culture under constant temperature. The changes in gut flora between the different groups were compared in terms of E.coli, Bacteroides, Bifidobacterium, and Enterococcus. RESULTS: Compared with the control group, the total bacteria, Bacteroid, Enterococcus, Bifidobacterium were all significantly decreased(P<0.05), while the E.coli count and the bacillus/coccus ratio were significantly elevated(P<0.05). In the bowel preparation group, the total bacteria count, Bacteroid, Enterococcus, Bifidobacterium were all significantly decreased(P<0.05), while the E.coli count remained stable(P>0.05) and the bacillus/coccus ratio was significantly elevated(P<0.05). In the fasting group, the total bacteria count, Bacteroid, Enterococcus, Bifidobacterium were all significantly decreased(P<0.05), while the E.coli count remained stable(P>0.05) and the bacillus/coccus ratio was significantly elevated(P<0.05). Early postoperative feeding increased E.coli, Enterococcus, and total bacteria count(P<0.05), and lowered bacillus/coccus ratio(P<0.05) as compared to the fasting group. CONCLUSIONS: Antibiotics, bowel preparation, and fasting have influence on the gut flora of SD rats in count and bacillus/coccus ratio, leading to dysbiosis. Early postoperative feeding may improve dysbiosis.