BACKGROUND With the increasing incidence of proximal gastric cancer,laparoscopic proximal gastrectomy has been applied.However,reflux esophagitis often occurs after traditional esophagogastric anastomosis.In order to ...BACKGROUND With the increasing incidence of proximal gastric cancer,laparoscopic proximal gastrectomy has been applied.However,reflux esophagitis often occurs after traditional esophagogastric anastomosis.In order to solve this problem,several methods of digestive tract reconstruction have emerged,but the most satisfying method remains to be discussed.Therefore,we modified traditional Kamikawa anastomosis to investigate the appropriate digestive tract reconstruction in laparo-scopic proximal gastrectomy.All the patients were successfully operated on without conversion to laparotomy.The duration of operation and digestive tract reconstruction were 203.500(150-224)min and 87.500(73-111)min,respectively.The intraoperative amount of bleeding was 20.500 mL±0.696 mL.The time of postoperative first flatus,the first postoperative fluid intake,and the postoperative length of stay were 2(1-3)d,4(3-5)d,and 9(8-10)d,respectively.All the patients were followed up for 12-23 months.The body mass index at 6 and 12 months after surgery were 22.577 kg/m2±3.098 kg/m2 and 22.594 kg/m2±3.207 kg/m2,respectively.The nutrition risk screening 2002 score,the patient-generated subjective global assessment score,and the gastroesophageal reflux disease scale score were good at 6 and 12 months after surgery.Reflux esophagitis and anastomotic stenosis were not observed in any of the patients during their 12-month postoperative gastroscopy or upper gastrointestinal tract visits.All the patients exhibited no tumor recurrence or metastasis.CONCLUSION The modified Kamikawa anastomosis is safe and feasible for laparoscopic proximal gastrectomy and has good antireflux effects and nutritional status.展开更多
Objective：This study proposed a modified Blumgart anastomosis（m-BA）that uses a firm ligation of the main pancreatic duct with a supporting tube to replace the pancreatic duct-to-jejunum mucosa anastomosis,with the ...Objective：This study proposed a modified Blumgart anastomosis（m-BA）that uses a firm ligation of the main pancreatic duct with a supporting tube to replace the pancreatic duct-to-jejunum mucosa anastomosis,with the aim of simplifying the complicated steps of the conventional BA（c-BA）.Thus,we observe if a difference in the risk of postoperative pancreatic fistula（POPF）exists between the two methods.Methods：The m-BA anastomosis method has been used since 2010.From October 2011 to October 2015,147 patients who underwent pancreatoduodenectomy（PD）using BA in Tianjin Medical University Cancer Institute and Hospital were enrolled in this study.According to the type of pancreatojejunostomy（PJ）,50 patients underwent m-BA and 97 received c-BA.The two patient cohorts were compared prospectively to some extent but not randomized,and the evaluated variables were operation time,the incidence rate of POPF,and other perioperative complications.Results：The operation time showed no significant difference（P〉0.05）between the two groups,but the time of duct-to-mucosa anastomosis in the m-BA group was much shorter than that in the c-BA group（P〈0.001）.The incidence rate of clinically relevant POPF was 12.0%（6/50）in the modified group and 10.3%（10/97）in the conventional group（P〉0.05）,which means that the modified anastomosis method did not cause additional pancreatic leakage.The mean length of postoperative hospital stay of the m-BA group was 23 days,and that of the c-BA group was 22 days（P〉0.05）.Conclusions：Compared with the conventional BA,we suggest that the modified BA is a feasible,safe,and effective operation method for P J of PD with no sacrifice of surgical quality.In the multivariate analysis,we also found that body mass index（≥25展开更多
A 63-year-old man presented at our hospital with right upper abdomen pain and fever for 4 d.The patient's magnetic resonance cholangiopancreatography revealed dilated common bile duct and choledocholithiasis.In hi...A 63-year-old man presented at our hospital with right upper abdomen pain and fever for 4 d.The patient's magnetic resonance cholangiopancreatography revealed dilated common bile duct and choledocholithiasis.In his past history,he received proximal gastrectomy and modified double tracks anastomosis.Endoscopic retrograde cholangiopancretography in modified double tracks anastomosis,especially accompanied with anastomotic stenosis,has been rarely reported.In the present case,the duodenoscope was successfully introduced over the guidewire and the stone taken out using a basket.The patient had good palliation of his symptoms after removal of the stone.展开更多
To optimize the efficiency of ileocolic anastomosis following right hemicolectomy,several variations of the surgical technique have been tested.These include performing the anastomosis intra-or extracorporeally or per...To optimize the efficiency of ileocolic anastomosis following right hemicolectomy,several variations of the surgical technique have been tested.These include performing the anastomosis intra-or extracorporeally or performing a stapled or hand-sewn anastomosis.Among the least studied is the configuration of the two stumps(i.e.,isoperistaltic or antiperistaltic)in the case of a side-to-side anastomosis.The purpose of the present study is to compare the isoperistaltic and antiperistaltic side-to-side anastomotic configuration after right hemicolectomy by reviewing the relevant literature.High-quality literature is scarce,with only three studies directly comparing the two alternatives,and no study has revealed any significant differences in the incidence of anastomosis-related complications such as leakage,stenosis,or bleeding.However,there may be a trend towards an earlier recovery of intestinal function following antiperistaltic anastomosis.Finally,existing data do not identify a certain anastomotic configuration(i.e.,isoperistaltic or antiperistaltic)as superior over the other.Thus,the most appropriate approach is to master both anastomotic techniques and select between the two configurations based on each individual case scenario.展开更多
Modified laparoscopic microsurgical tubal anastomosis is an alternative for microsurgical anastomosis via laparotomy to reverse sterilization in women with renewed child wish.The current study aims to evaluate the fer...Modified laparoscopic microsurgical tubal anastomosis is an alternative for microsurgical anastomosis via laparotomy to reverse sterilization in women with renewed child wish.The current study aims to evaluate the fertility outcome after modified laparoscopic microsurgical tubal anastomosis.A retrospective study was performed.Fifty-eight women who underwent modified laparoscopic microsurgical tubal anastomosis were monitored to investigate the fertility outcome and characteristics of this new technology.Of the 58 patients,the cumulative pregnancy rate(PR)in the 42 patients with follow-up data was 23.8%(10/42),57.1%(24/42),66.7%(28/42),and 73.8%(31/42)within 6,12,24,and 36 months after surgery,respectively.The intrauterine PR was 69.0%(29/42).Two patients(4.8%)had ectopic pregnancies that occurred within 24 months of surgery;three cases ended in spontaneous abortion.The delivery rate was 83.9%(26/31).The length of operating time was 1.20.3 h,with a range of 1.0–2.5 h(60–145 min),and the mean time was approximately 75 min.The blood loss was relatively small,between 10 and 50 ml with an average amount of 22 ml.Thus,the modified laparoscopic tubal anastomosis is a highly successful procedure and a viable alternative to open abdominal microsurgical approaches.Compared with the traditional laparoscopic tubal sterilization reversal,this modified approach has three advantages:(1)less invasive approach via a trocar reduction;(2)remodeling of tube is better performing tied together after 3–4 sutures;and(3)faster operating time.展开更多
BACKGROUND Candy cane syndrome(CCS)is a condition that occurs following gastrectomy or gastric bypass.CCS remains underrecognized,yet its prevalence is likely to rise due to the obesity epidemic and increased use of b...BACKGROUND Candy cane syndrome(CCS)is a condition that occurs following gastrectomy or gastric bypass.CCS remains underrecognized,yet its prevalence is likely to rise due to the obesity epidemic and increased use of bariatric surgery.No previous literature review on this subject has been published.AIM To collate the current knowledge on CCS.METHODS A literature search was conducted with PubMed and Google Scholar for studies from May 2007,until March 2023.The bibliographies of the retrieved articles were manually searched for additional relevant articles.RESULTS Twenty-one articles were identified(135 patients).Abdominal pain,nausea/vomiting,and reflux were the most reported symptoms.Upper gastrointestinal(GI)series and endoscopy were performed for diagnosis.Surgical resection of the blind limb was performed in 13 studies with resolution of symptoms in 73%-100%.In surgical series,9 complications were reported with no mortality.One study reported the surgical construction of a jejunal pouch with clinical success.Six studies described endoscopic approaches with 100%clinical success and no complications.In one case report,endoscopic dilation did not improve the patient’s symptoms.CONCLUSION CCS remains underrecognized due to lack of knowledge about this condition.The growth of the obesity epidemic worldwide and the increase in bariatric surgery are likely to increase its prevalence.CCS can be prevented if an elongated blind loop is avoided or if a jejunal pouch is constructed after total gastrectomy.Diagnosis should be based on symptoms,endoscopy,and upper GI series.Blind loop resection is curative but complex and associated with significant complications.Endoscopic management using different approaches to divert flow is effective and should be further explored.展开更多
基金Supported by the Fujian Medical University Sailing Fund General Project,No.2022QH1117Key Clinical Specialty Discipline Construction Program of Fujian,Fujian Health Medicine and Politics,No.[2022]884.
文摘BACKGROUND With the increasing incidence of proximal gastric cancer,laparoscopic proximal gastrectomy has been applied.However,reflux esophagitis often occurs after traditional esophagogastric anastomosis.In order to solve this problem,several methods of digestive tract reconstruction have emerged,but the most satisfying method remains to be discussed.Therefore,we modified traditional Kamikawa anastomosis to investigate the appropriate digestive tract reconstruction in laparo-scopic proximal gastrectomy.All the patients were successfully operated on without conversion to laparotomy.The duration of operation and digestive tract reconstruction were 203.500(150-224)min and 87.500(73-111)min,respectively.The intraoperative amount of bleeding was 20.500 mL±0.696 mL.The time of postoperative first flatus,the first postoperative fluid intake,and the postoperative length of stay were 2(1-3)d,4(3-5)d,and 9(8-10)d,respectively.All the patients were followed up for 12-23 months.The body mass index at 6 and 12 months after surgery were 22.577 kg/m2±3.098 kg/m2 and 22.594 kg/m2±3.207 kg/m2,respectively.The nutrition risk screening 2002 score,the patient-generated subjective global assessment score,and the gastroesophageal reflux disease scale score were good at 6 and 12 months after surgery.Reflux esophagitis and anastomotic stenosis were not observed in any of the patients during their 12-month postoperative gastroscopy or upper gastrointestinal tract visits.All the patients exhibited no tumor recurrence or metastasis.CONCLUSION The modified Kamikawa anastomosis is safe and feasible for laparoscopic proximal gastrectomy and has good antireflux effects and nutritional status.
文摘Objective：This study proposed a modified Blumgart anastomosis（m-BA）that uses a firm ligation of the main pancreatic duct with a supporting tube to replace the pancreatic duct-to-jejunum mucosa anastomosis,with the aim of simplifying the complicated steps of the conventional BA（c-BA）.Thus,we observe if a difference in the risk of postoperative pancreatic fistula（POPF）exists between the two methods.Methods：The m-BA anastomosis method has been used since 2010.From October 2011 to October 2015,147 patients who underwent pancreatoduodenectomy（PD）using BA in Tianjin Medical University Cancer Institute and Hospital were enrolled in this study.According to the type of pancreatojejunostomy（PJ）,50 patients underwent m-BA and 97 received c-BA.The two patient cohorts were compared prospectively to some extent but not randomized,and the evaluated variables were operation time,the incidence rate of POPF,and other perioperative complications.Results：The operation time showed no significant difference（P〉0.05）between the two groups,but the time of duct-to-mucosa anastomosis in the m-BA group was much shorter than that in the c-BA group（P〈0.001）.The incidence rate of clinically relevant POPF was 12.0%（6/50）in the modified group and 10.3%（10/97）in the conventional group（P〉0.05）,which means that the modified anastomosis method did not cause additional pancreatic leakage.The mean length of postoperative hospital stay of the m-BA group was 23 days,and that of the c-BA group was 22 days（P〉0.05）.Conclusions：Compared with the conventional BA,we suggest that the modified BA is a feasible,safe,and effective operation method for P J of PD with no sacrifice of surgical quality.In the multivariate analysis,we also found that body mass index（≥25
基金Supported by the Key Research and Development Program of the Science and Technology Department,Jiangsu Province,China,No.BE2015722the Science and Technology Development Fund Project of Nanjing Medical University,Jiangsu Province,China,No.2011NJMU246
文摘A 63-year-old man presented at our hospital with right upper abdomen pain and fever for 4 d.The patient's magnetic resonance cholangiopancreatography revealed dilated common bile duct and choledocholithiasis.In his past history,he received proximal gastrectomy and modified double tracks anastomosis.Endoscopic retrograde cholangiopancretography in modified double tracks anastomosis,especially accompanied with anastomotic stenosis,has been rarely reported.In the present case,the duodenoscope was successfully introduced over the guidewire and the stone taken out using a basket.The patient had good palliation of his symptoms after removal of the stone.
文摘To optimize the efficiency of ileocolic anastomosis following right hemicolectomy,several variations of the surgical technique have been tested.These include performing the anastomosis intra-or extracorporeally or performing a stapled or hand-sewn anastomosis.Among the least studied is the configuration of the two stumps(i.e.,isoperistaltic or antiperistaltic)in the case of a side-to-side anastomosis.The purpose of the present study is to compare the isoperistaltic and antiperistaltic side-to-side anastomotic configuration after right hemicolectomy by reviewing the relevant literature.High-quality literature is scarce,with only three studies directly comparing the two alternatives,and no study has revealed any significant differences in the incidence of anastomosis-related complications such as leakage,stenosis,or bleeding.However,there may be a trend towards an earlier recovery of intestinal function following antiperistaltic anastomosis.Finally,existing data do not identify a certain anastomotic configuration(i.e.,isoperistaltic or antiperistaltic)as superior over the other.Thus,the most appropriate approach is to master both anastomotic techniques and select between the two configurations based on each individual case scenario.
基金supported by grants from the National Natural Science Foundation of China(Grant No.30671093)the“973”program of China(No.2007CB948104).
文摘Modified laparoscopic microsurgical tubal anastomosis is an alternative for microsurgical anastomosis via laparotomy to reverse sterilization in women with renewed child wish.The current study aims to evaluate the fertility outcome after modified laparoscopic microsurgical tubal anastomosis.A retrospective study was performed.Fifty-eight women who underwent modified laparoscopic microsurgical tubal anastomosis were monitored to investigate the fertility outcome and characteristics of this new technology.Of the 58 patients,the cumulative pregnancy rate(PR)in the 42 patients with follow-up data was 23.8%(10/42),57.1%(24/42),66.7%(28/42),and 73.8%(31/42)within 6,12,24,and 36 months after surgery,respectively.The intrauterine PR was 69.0%(29/42).Two patients(4.8%)had ectopic pregnancies that occurred within 24 months of surgery;three cases ended in spontaneous abortion.The delivery rate was 83.9%(26/31).The length of operating time was 1.20.3 h,with a range of 1.0–2.5 h(60–145 min),and the mean time was approximately 75 min.The blood loss was relatively small,between 10 and 50 ml with an average amount of 22 ml.Thus,the modified laparoscopic tubal anastomosis is a highly successful procedure and a viable alternative to open abdominal microsurgical approaches.Compared with the traditional laparoscopic tubal sterilization reversal,this modified approach has three advantages:(1)less invasive approach via a trocar reduction;(2)remodeling of tube is better performing tied together after 3–4 sutures;and(3)faster operating time.
文摘BACKGROUND Candy cane syndrome(CCS)is a condition that occurs following gastrectomy or gastric bypass.CCS remains underrecognized,yet its prevalence is likely to rise due to the obesity epidemic and increased use of bariatric surgery.No previous literature review on this subject has been published.AIM To collate the current knowledge on CCS.METHODS A literature search was conducted with PubMed and Google Scholar for studies from May 2007,until March 2023.The bibliographies of the retrieved articles were manually searched for additional relevant articles.RESULTS Twenty-one articles were identified(135 patients).Abdominal pain,nausea/vomiting,and reflux were the most reported symptoms.Upper gastrointestinal(GI)series and endoscopy were performed for diagnosis.Surgical resection of the blind limb was performed in 13 studies with resolution of symptoms in 73%-100%.In surgical series,9 complications were reported with no mortality.One study reported the surgical construction of a jejunal pouch with clinical success.Six studies described endoscopic approaches with 100%clinical success and no complications.In one case report,endoscopic dilation did not improve the patient’s symptoms.CONCLUSION CCS remains underrecognized due to lack of knowledge about this condition.The growth of the obesity epidemic worldwide and the increase in bariatric surgery are likely to increase its prevalence.CCS can be prevented if an elongated blind loop is avoided or if a jejunal pouch is constructed after total gastrectomy.Diagnosis should be based on symptoms,endoscopy,and upper GI series.Blind loop resection is curative but complex and associated with significant complications.Endoscopic management using different approaches to divert flow is effective and should be further explored.
