AIM: To compare the outcomes of hand-sewn(HS) and linearly stapled(LS) esophagogastric anastomosis for esophageal cancer.METHODS: Before beginning this study, a rigorous protocol was established according to the recom...AIM: To compare the outcomes of hand-sewn(HS) and linearly stapled(LS) esophagogastric anastomosis for esophageal cancer.METHODS: Before beginning this study, a rigorous protocol was established according to the recommendations of the Cochrane Collaboration. Databases and references were searched for all randomizedcontrolled trials and comparative clinical studies that compared LS with HS esophagogastric anastomosis for esophageal cancer. The primary outcomes compared were anastomotic leak and stricture. Subgroup analyses were performed according to site of anastomosis.RESULTS: Fifteen studies were used, comprising 3203 patients(n = 2027 LS and 1176 HS). Primary outcome analysis revealed a significant decrease in anastomotic leakage(RR = 0.51, 95%CI: 0.41-0.65; P < 0.00001) a s s o c i a t e d w i t h L S a n a s t o m o s i s. A s i g n i f i c a n t l y reduced rate of anastomotic stricture associated with LS was also found(RR = 0.56, 95%CI: 0.49-0.64; P < 0.00001). A subgroup analysis according to the site of anastomosis revealed a significantly reduced rate of anastomotic stricture(P < 0.00001). Although there was no significant difference in the decrease in thoracic anastomotic leakage, there was a significant decrease in cervical anastomotic leakage associated with LS(P < 0.00001).CONCLUSION: This meta-analysis indicates that the LS technique contributes to a reduced rate of leakage and stricture compared with the HS method.展开更多
Background: Since January 12005, the outcomes of bariatric surgeries have been recorded in Germany. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at Otto-von-G...Background: Since January 12005, the outcomes of bariatric surgeries have been recorded in Germany. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at Otto-von-Guericke University Magdeburg.?Methods: Data are collected in an online data bank. Data collection began in 2005 for the results of Roux-en-Y Gastric Bypass (RYGB). In addition to primary bariatric operations, data regarding the complications and the amelioration of comorbidities have been analyzed. Participation in the quality assurance study is required for all certified centers in Germany.?Results: Roux-en-Y Gastric Bypass is the most popular bariatric operation in Germany. There were 5115 operations performed from 2005 to 2010. A circular anastomosis was performed in 1587 patients, and a linear anastomosis was performed in 2734 patients. In 783 patients the hand-sewn technique was used. The leakage rate for the linear technique is 1.6%, and the leakage rate is 1.2% for circular anastomosis and 1.4% for hand-sewn technique. The overall postoperative complication rate was significantly higher using the circular technique than using the linear or hand-sewn approach.?Conclusion: RYGB is a popular procedure in Germany. The complication rate has decreased since 2005. A comparison of hand sewn versus linear and versus circular anastomosis indicated a higher complication rate in circular gastrojejunal junctions.展开更多
Objective:Minimally invasive surgery has become common in surgical resections of gastric subepithelial tumors.An endostapler technique is simple and easy to perform when cutting the stomach.Gastrotomy using a hand-sew...Objective:Minimally invasive surgery has become common in surgical resections of gastric subepithelial tumors.An endostapler technique is simple and easy to perform when cutting the stomach.Gastrotomy using a hand-sewn repair is a new approach for identifying and removing gastric subepithelial tumors,but few studies have evaluated its efficacy.In this study,we demonstrated the safety and effectiveness of this novel technique using a robot-assisted approach.Materials and methods:A retrospective cohorts of all patients who presented with gastric subepithelial tumors and underwent robotic or laparoscopic resection at Ramathibodi Hospital from 2012 to 2018 was reviewed.Surgical outcomes and complications of the robot-assisted approach with a hand-sewn repair were analyzed and compared to those of the laparoscopic linear stapler technique.Results:In total,25 patients were included in this study.Most of the subepithelial tumors were gastrointestinal stromal tumors(17 patients,68%).Ten patients(40%)underwent a robot-assisted procedure with a hand-sewing technique,and 15 patients underwent a laparoscopic linear stapler procedure.Mean tumor size was 3.79±1.35 cm in the robot-assisted procedure with a hand-sewing technique group and 3.52±1.88 cm in the laparoscopic linear stapler procedure group.The former experienced a longer operative time(261±54 vs 144±64 minutes,p<0.001)and a longer time to return to a normal diet(5.7±2.0 vs 4.0±1.4 days,p=0.028).Neither group experienced perioperative complications or mortality.Conclusion:Although the time to return to a normal diet and operative time were significantly longer compared to a laparoscopic procedure using a linear stapler,the robot-assisted approach using a handsewn repair for gastric subepithelial tumors is feasible,effective,and safe.This can be an alternative for the surgical treatment of gastric subepithelial lesions.展开更多
AIM: To assess the efficacy and safety of intracorporeal esophagojejunostomy in patients undergoing laparoscopic total gastrectomy(LTG) for gastric cancer.METHODS: A retrospective review of 81 consecutive patients who...AIM: To assess the efficacy and safety of intracorporeal esophagojejunostomy in patients undergoing laparoscopic total gastrectomy(LTG) for gastric cancer.METHODS: A retrospective review of 81 consecutive patients who underwent LTG with the same surgical team between November 2007 and July 2014 was performed. Four types of intracorporeal esophagojejunostomy using staplers or hand-sewn suturing were performed after LTG. Data on clinicopatholgoical characteristics, occurrence of complications, postoperative recovery, anastomotic time, and operation time among the surgical groups were obtained through medical records.RESULTS: The average operation time was 288.7 min, the average anastomotic time was 54.3 min, and the average estimated blood loss was 82.7 m L. There were no cases of conversion to open surgery. The first flatus was observed around 3.7 d, while the liquid diet was started, on average, from 4.9 d. The average postoperative hospital stay was 10.1 d. Postoperative complications occurred in 14 patients, nearly 17.3%.However, there were no cases of postoperative death.CONCLUSION: LTG performed with intracorporeal esophagojejunostomy using laparoscopic staplers or hand-sewn suturing is feasible and safe. The surgical results were acceptable from the perspective of minimal invasiveness.展开更多
文摘AIM: To compare the outcomes of hand-sewn(HS) and linearly stapled(LS) esophagogastric anastomosis for esophageal cancer.METHODS: Before beginning this study, a rigorous protocol was established according to the recommendations of the Cochrane Collaboration. Databases and references were searched for all randomizedcontrolled trials and comparative clinical studies that compared LS with HS esophagogastric anastomosis for esophageal cancer. The primary outcomes compared were anastomotic leak and stricture. Subgroup analyses were performed according to site of anastomosis.RESULTS: Fifteen studies were used, comprising 3203 patients(n = 2027 LS and 1176 HS). Primary outcome analysis revealed a significant decrease in anastomotic leakage(RR = 0.51, 95%CI: 0.41-0.65; P < 0.00001) a s s o c i a t e d w i t h L S a n a s t o m o s i s. A s i g n i f i c a n t l y reduced rate of anastomotic stricture associated with LS was also found(RR = 0.56, 95%CI: 0.49-0.64; P < 0.00001). A subgroup analysis according to the site of anastomosis revealed a significantly reduced rate of anastomotic stricture(P < 0.00001). Although there was no significant difference in the decrease in thoracic anastomotic leakage, there was a significant decrease in cervical anastomotic leakage associated with LS(P < 0.00001).CONCLUSION: This meta-analysis indicates that the LS technique contributes to a reduced rate of leakage and stricture compared with the HS method.
文摘Background: Since January 12005, the outcomes of bariatric surgeries have been recorded in Germany. All data are registered prospectively in cooperation with the Institute of Quality Assurance in Surgery at Otto-von-Guericke University Magdeburg.?Methods: Data are collected in an online data bank. Data collection began in 2005 for the results of Roux-en-Y Gastric Bypass (RYGB). In addition to primary bariatric operations, data regarding the complications and the amelioration of comorbidities have been analyzed. Participation in the quality assurance study is required for all certified centers in Germany.?Results: Roux-en-Y Gastric Bypass is the most popular bariatric operation in Germany. There were 5115 operations performed from 2005 to 2010. A circular anastomosis was performed in 1587 patients, and a linear anastomosis was performed in 2734 patients. In 783 patients the hand-sewn technique was used. The leakage rate for the linear technique is 1.6%, and the leakage rate is 1.2% for circular anastomosis and 1.4% for hand-sewn technique. The overall postoperative complication rate was significantly higher using the circular technique than using the linear or hand-sewn approach.?Conclusion: RYGB is a popular procedure in Germany. The complication rate has decreased since 2005. A comparison of hand sewn versus linear and versus circular anastomosis indicated a higher complication rate in circular gastrojejunal junctions.
文摘Objective:Minimally invasive surgery has become common in surgical resections of gastric subepithelial tumors.An endostapler technique is simple and easy to perform when cutting the stomach.Gastrotomy using a hand-sewn repair is a new approach for identifying and removing gastric subepithelial tumors,but few studies have evaluated its efficacy.In this study,we demonstrated the safety and effectiveness of this novel technique using a robot-assisted approach.Materials and methods:A retrospective cohorts of all patients who presented with gastric subepithelial tumors and underwent robotic or laparoscopic resection at Ramathibodi Hospital from 2012 to 2018 was reviewed.Surgical outcomes and complications of the robot-assisted approach with a hand-sewn repair were analyzed and compared to those of the laparoscopic linear stapler technique.Results:In total,25 patients were included in this study.Most of the subepithelial tumors were gastrointestinal stromal tumors(17 patients,68%).Ten patients(40%)underwent a robot-assisted procedure with a hand-sewing technique,and 15 patients underwent a laparoscopic linear stapler procedure.Mean tumor size was 3.79±1.35 cm in the robot-assisted procedure with a hand-sewing technique group and 3.52±1.88 cm in the laparoscopic linear stapler procedure group.The former experienced a longer operative time(261±54 vs 144±64 minutes,p<0.001)and a longer time to return to a normal diet(5.7±2.0 vs 4.0±1.4 days,p=0.028).Neither group experienced perioperative complications or mortality.Conclusion:Although the time to return to a normal diet and operative time were significantly longer compared to a laparoscopic procedure using a linear stapler,the robot-assisted approach using a handsewn repair for gastric subepithelial tumors is feasible,effective,and safe.This can be an alternative for the surgical treatment of gastric subepithelial lesions.
基金Supported by Natural Science Foundation of Zhejiang Province,No.LY12H16026Chinese Medical Technology Foundation of Zhejiang Province,China,No.2012ZA087
文摘AIM: To assess the efficacy and safety of intracorporeal esophagojejunostomy in patients undergoing laparoscopic total gastrectomy(LTG) for gastric cancer.METHODS: A retrospective review of 81 consecutive patients who underwent LTG with the same surgical team between November 2007 and July 2014 was performed. Four types of intracorporeal esophagojejunostomy using staplers or hand-sewn suturing were performed after LTG. Data on clinicopatholgoical characteristics, occurrence of complications, postoperative recovery, anastomotic time, and operation time among the surgical groups were obtained through medical records.RESULTS: The average operation time was 288.7 min, the average anastomotic time was 54.3 min, and the average estimated blood loss was 82.7 m L. There were no cases of conversion to open surgery. The first flatus was observed around 3.7 d, while the liquid diet was started, on average, from 4.9 d. The average postoperative hospital stay was 10.1 d. Postoperative complications occurred in 14 patients, nearly 17.3%.However, there were no cases of postoperative death.CONCLUSION: LTG performed with intracorporeal esophagojejunostomy using laparoscopic staplers or hand-sewn suturing is feasible and safe. The surgical results were acceptable from the perspective of minimal invasiveness.
