How to examine anastomotic integrity intraoperatively in totally laparoscopic radical gastrectomy? Methylene blue testing prevents technical defect-related anastomotic leaks

BACKGROUND Intraoperative methylene blue testing(IMBT),air leak testing,or endoscopy is used to assess the anastomotic integrity of esophagojejunostomy during open total gastrectomy for gastric cancer.Totally laparoscopic radical gastrectomy has been widely used to treat gastric cancer in the last few decades.However,reports on testing anastomotic integrity in totally laparoscopic radical gastrectomy are limited.AIM To explore the effects of IMBT on the incidence of postoperative anastomotic leaks(PALs)and identify the risk factors for PALs in totally laparoscopic radical gastrectomy.METHODS From January 2017 to December 2019,patients who underwent totally laparoscopic radical gastrectomy at the Shaanxi Provincial People's Hospital were retrospectively analyzed.According to whether or not they experienced an IMBT,the patients were divided into an IMBT group and a control group.If the IMBT was positive,an intraoperative suture was required to reinforce the anastomosis.The difference in the incidence of PALs was compared,and the risk factors were investigated.RESULTS This study consisted of 513 patients,211 in the IMBT group and 302 in the control group.Positive IMBT was shown in seven patients(3.3%)in the IMBT group,and no PAL occurred in these patients after suture reinforcement.Multivariate analysis showed that risk factors for predicting positive IMBT were body mass index(BMI)>25 kg/m2(hazard ratio[HR]=8.357,P=0.009),operation time>4 h(HR=55.881,P=0.002),and insufficient surgical experience(HR=15.286,P=0.010).Moreover,15 patients(2.9%)developed PALs in 513 patients,and the rates of PALs were significantly lower in the IMBT group than in the control group[2 of 211 patients(0.9%)vs 13 of 302 patients(4.3%),P=0.0026].Further analysis demonstrated that preoperative complications(HR=13.128,P=0.017),totally laparoscopic total gastrectomy(HR=9.075,P=0.043),and neoadjuvant chemotherapy(HR=7.150,P=0.008)were independent risk factors for PALs.CONCLUSION IMBT is an effective method to evaluate the integrity of anastomosis during totally laparoscopic radical gastrectomy,thus preventing technical defect-related anastomotic leaks.Preoperative complications,totally laparoscopic total gastrectomy,and neoadjuvant chemotherapy are independent risk factors for PALs.

Multifactor analysis of the technique in total laparoscopic gastric cancer

BACKGROUND Esophageal gastric anastomosis is a common surgical technique used to treat patients with gastric cancer who undergo total gastrectomy.However,using simple anastomosis techniques alone may not meet the needs of patients in some cases and can lead to complications such as anastomotic stenosis and ulceration.In order to overcome these issues and improve patient prognosis,muscle flap reconstruction technique has emerged.Muscle flap reconstruction is a method of improving gastric-esophageal anastomosis by transplanting muscle tissue.By covering the anastomotic site with muscle tissue,it not only enhances the stability of the anastomosis site but also increases blood supply,promoting healing and recovery of the anastomosis.Therefore,the use of muscle flap reconstruction technique in esophageal gastric anastomosis during total gastrectomy for gastric cancer is increasingly widely applied.AIM To determine the effectiveness of esophagogastric anastomosis using the muscle flap reconstruction technology in total abdominal gastrectomy for gastric cancer and perform follow-up experiments to understand the factors affecting patients’prognosis.METHODS The study subjects were 60 patients with gastric cancer who were admitted to our hospital between October 2018 and January 2022.All patients underwent esopha-gogastric anastomosis using the double muscle flap reconstruction technology in total abdominal gastrectomy.Perioperative indicators were determined,and INTRODUCTION Gastric cancer is one of the most common tumors of the digestive system worldwide.Although gastric cancer may not have significant manifestations in the early stage,as the disease progresses,systemic symptoms such as emaciation,anemia,and gastric perforation are observed[1].Surgery is the main treatment strategy for gastric cancer.With recent advances in total laparoscopy,total laparoscopic radical resection has gradually become an important treatment strategy for gastric cancer.Conventional laparoscopic surgery may require at least 5-6 incisions,whereas total laparoscopic surgery requires only 3-4 small incisions,decreasing surgical trauma and postoperative pain[2].Furthermore,because total laparoscopic surgery is less invasive than conventional laparoscopic surgery,patients can generally return to normal living and working conditions more quickly[3].Moreover,total laparoscopic surgery does not leave obvious surgical scars;therefore,it is advantageous for patients who pay attention to appearance[4].Esophagogastrostomy is a method used to repair gastrointestinal anastomosis,called the“double muscle valve”.This technique requires folding the fundus of the stomach,followed by sealing it with two layers of tissue,forming a structure similar to a valve.The application of esophagogastrostomy to total laparoscopic radical resection for gastric cancer can effectively decrease the incidence of complications such as anastomotic incontinence and bile reflux and improve the surgical cure rate and postoperative quality of life,which is a recent topic of interest for surgeons.At present,systematic multivariate analyses of the application effects of esophagogastrostomy in total laparoscopic surgery for gastric cancer and their effects on prognosis remain scarce[5].In the present study,we conducted surgery and postoperative follow-up of patients with gastric cancer and collected relevant clinical data for esophagogastric anastomosis during postoperative resection for gastric cancer to ACKNOWLEDGEMENTS I would like to express my sincere thanks to all those who participated in the manuscript.