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
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
BACKGROUND Magnetic compression anastomosis(MCA)is a novel suture-free reconstruction of the digestive tract.It has been used in gastrointestinal anastomosis,jejunal anastomosis,cholangioenteric anastomosis and so on....BACKGROUND Magnetic compression anastomosis(MCA)is a novel suture-free reconstruction of the digestive tract.It has been used in gastrointestinal anastomosis,jejunal anastomosis,cholangioenteric anastomosis and so on.The traditional operative outcomes of congenital esophageal atresia and benign esophageal stricture are poor,and there are too many complications postoperatively.AIM To test MCA technology to reconstruct the esophagus in dogs,prior to studying the feasibility and safety of MCA in humans.METHODS Thirty-six dogs were randomized into either the study or control group(n=18 per group).The dogs in the study group were subjected to end-to-end esophageal anastomosis with the magnetic compression device,while those in the control group underwent hand-sewn anastomosis with 4-0 absorbable multifilament Vicryl.We used interrupted single-layer inverting sutures.The anastomosis time,gross appearance,weight and pathology of the anastomosis were evaluated at one month,three months and six months postoperatively.RESULTS The anastomosis time of the MCA group was shorter than that of the hand-sewn group(7.5±1.0 min vs 12.5±1.8 min,P<0.01).In the MCA group,X-ray examination was performed every day to locate the magnetic device in the esophagus before the magnetic device fell off from the esophagus.In the hand-sewn group,dogs did not undergo X-ray examination.One month after the surgeries,the mean weight of the dogs in the hand-sewn group had decreased more than that of the dogs in the MCA group(11.63±0.71 kg vs 12.73±0.80 kg,P<0.05).At 3 mo and 6 mo after the operation,the dogs’weights were similar between the two groups(13.75±0.84 kg vs 14.03±0.82 kg,14.93±0.80 kg vs 15.44±0.47 kg).The number of inflammatory cells in MCA group was lower than that in hand-sewn group on 1 mo after operation.CONCLUSION MCA is an effective and safe method for esophageal reconstruction.The anastomosis time of the MCA group was less than that of the hand-sewn group.This study shows that MCA technology may be applied to human esophageal reconstruction,provided these favorable results are confirmed by more publications.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.
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.
基金Supported by the National Natural Science Foundation of China,No. 82170676Natural Science Foundation of Shaanxi Provincial Key Industries Innovation Chain (Cluster)-Social Development Project,No. 2020ZDLSF02-03
文摘BACKGROUND Magnetic compression anastomosis(MCA)is a novel suture-free reconstruction of the digestive tract.It has been used in gastrointestinal anastomosis,jejunal anastomosis,cholangioenteric anastomosis and so on.The traditional operative outcomes of congenital esophageal atresia and benign esophageal stricture are poor,and there are too many complications postoperatively.AIM To test MCA technology to reconstruct the esophagus in dogs,prior to studying the feasibility and safety of MCA in humans.METHODS Thirty-six dogs were randomized into either the study or control group(n=18 per group).The dogs in the study group were subjected to end-to-end esophageal anastomosis with the magnetic compression device,while those in the control group underwent hand-sewn anastomosis with 4-0 absorbable multifilament Vicryl.We used interrupted single-layer inverting sutures.The anastomosis time,gross appearance,weight and pathology of the anastomosis were evaluated at one month,three months and six months postoperatively.RESULTS The anastomosis time of the MCA group was shorter than that of the hand-sewn group(7.5±1.0 min vs 12.5±1.8 min,P<0.01).In the MCA group,X-ray examination was performed every day to locate the magnetic device in the esophagus before the magnetic device fell off from the esophagus.In the hand-sewn group,dogs did not undergo X-ray examination.One month after the surgeries,the mean weight of the dogs in the hand-sewn group had decreased more than that of the dogs in the MCA group(11.63±0.71 kg vs 12.73±0.80 kg,P<0.05).At 3 mo and 6 mo after the operation,the dogs’weights were similar between the two groups(13.75±0.84 kg vs 14.03±0.82 kg,14.93±0.80 kg vs 15.44±0.47 kg).The number of inflammatory cells in MCA group was lower than that in hand-sewn group on 1 mo after operation.CONCLUSION MCA is an effective and safe method for esophageal reconstruction.The anastomosis time of the MCA group was less than that of the hand-sewn group.This study shows that MCA technology may be applied to human esophageal reconstruction,provided these favorable results are confirmed by more publications.
