Compression anastomosis clip for gastrointestinal anastomosis

AIM: To investigate the feasibility of compression anastomosis clip (CAC) for gastrointestinal anastomosis proximal to the ileocecal junction. METHODS: Sixty-six patients undergoing gastrointe-stinal anastomosis proximal to the ileocecal junction were randomized into two groups according to the anastomotic method, CAC or stapler. RESULTS: The postoperative recovery of patients in CAC and stapled anastomosis groups was similar. No postoperative complication related to the anastomotic method was found in either group. Both upper gastrointestinal contrast radiography at the early postoperative course and endoscopic examination after a 6-mo follow-up showed a better healing at the compression anastomosis. CONCLUSION: CAC can be used not only in colonic surgery but also in gastrointestinal anastomosis. Our result strongly suggests that CAC anastomosis is safe in various complication circumstances. However, it should be further conf irmed with a larger patient sample.

When should endovascular gastrointestinal anastomosis transection Glissonean pedicle not be used in hepatectomy?A case report

BACKGROUND The literature on post-hepatectomy bile duct injury(PHBDI)is limited,lacking large sample retrospective studies and high-quality experience summaries.Therefore,we reported a special case of iatrogenic bile duct injury caused by Glissonean pedicle transection with endovascular gastrointestinal anastomosis(endo-GIA)during a right hepatectomy,analyzed the causes of this injury,and summarized the experience with this patient.CASE SUMMARY We present the case of a 66-year-old woman with recurrent abdominal pain and cholangitis due to intrahepatic cholangiectasis(Caroli's disease).Preoperative evaluation revealed that the lesion and dilated bile ducts were confined to the right liver,with right hepatic atrophy,left hepatic hypertrophy,and hilar translocation.This problem can be resolved by performing a standard right hepatectomy.Although the operation went well,jaundice occurred soon after the operation.Iatrogenic bile duct injury was considered after magnetic resonance cholangiopancreatography review,and the second operation were performed 10 d later.During the second operation,it was found that the endo-GIA had damaged the lateral wall of the hepatic duct and multiple titanium nails remained in the bile duct wall.This led to severe stenosis of the duct wall,and could not be repaired.Therefore,the injured bile duct was transected,and a hepatic-jejunal-lateral Roux-Y anastomosis was performed at the healthy part of the left hepatic duct.After this surgery,the patient had a smooth postoperative recovery,and the total bilirubin gradually decreased to normal.The patient was discharged 41 d after operation.No anastomotic stenosis was found at the 6 mo of follow-up.CONCLUSION Not all cases are suitable for endo-GIA transection of Glissonean pedicle,especially in cases of intrahepatic bile duct lesions.PHBDI caused by endo-GIA is very difficult to repair due to extensive ischemia,which requires special attention.

Total laparoscopic-assisted radical gastrectomy (D2+) with jejunal Roux-en-Y reconstruction

Total laparoscopic-assisted radical gastrectomy and the jejunal Roux-en-Y anastomosis were performed to treat cancer of the upper gastric body and fundic region. In the case of open anastomosis during total laparoscopic-assisted radical gastrectomy, an incision of 6-8 cm would be required due to the need for placing the stapler anvil. If using the Roux-en-Y procedure, however, the incision could be reduced to as small as 4-5 cm without increasing the length of operation and intraoperative bleeding that favors postoperative recovery.