Database : MEDLINE
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  1 / 2416 MEDLINE  
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PMID:28982875
Author:Virgilio E; Balducci G; Mercantini P; Ferri M; Bocchetti T; Caterino S; Salvi PF; Ziparo V; Cavallini M
Address:Medical and Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology "Sapienza", St. Andrea Hospital, Rome, Italy aresedo1992@yahoo.it edoardo.virgilio@uniroma1.it.
Title:Reconstruction After Distal Gastrectomy for Gastric Cancer: Billroth 2 or Roux-En-Y Procedure?
Source:Anticancer Res; 37(10):5595-5602, 2017 10.
ISSN:1791-7530
Country of publication:Greece
Language:eng
Abstract:BACKGROUND/AIM: Distal gastrectomy (DG) represents the only curative treatment for most mid-lower gastric cancers (GCs). As of 2017, however, no reconstructive modality to conduct after DG has gained unanimous consensus. Additionally, most authors have investigated Billroth 1 and Roux-en-Y (RY) rather than Billroth 2 (B2) reconstruction. We analyzed B2 and RY gastrojejunostomy to identify the preferable technique and augment the available information on B2 restoration. PATIENTS AND METHODS: We retrospectively selected 132 GC patients who were consecutively submitted to DG at our institution between April 2005 and February 2016. B2 and RY anastomosis were accomplished as methods of reconstruction (respectively 36 and 96 cases). We compared these techniques in terms of clinicopathological, surgical, postoperative and oncologic outcomes. RESULTS: Compared to RY gastrojejunostomy, B2 reconstruction was significantly associated with a greater mean number of harvested lymph nodes (26.03 vs. 21.65, p=0.045) but also with a longer hospital stay (22.8 vs. 15.7 days) (p=0.022) and higher readmission rate (28.57% vs. 3.1%, p<0.0001). On multivariate analysis, reconstruction method was the most significant independent prognostic factor for hospital readmission. CONCLUSION: In light of our results, we propose that B2 gastrojejunostomy deserves more study in order to better identify the best post-DG anastomosis.
Publication type:COMPARATIVE STUDY; JOURNAL ARTICLE


  2 / 2416 MEDLINE  
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PMID:28687510
Author:Khan AS; Williams G; Woolsey C; Liu J; Fields RC; Doyle MMB; Hawkins WG; Strasberg SM
Address:Division of Hepato-Pancreato-Biliary Surgery, Department of Surgery, Washington University School of Medicine, St Louis, MO.
Title:Flange Gastroenterostomy Results in Reduction in Delayed Gastric Emptying after Standard Pancreaticoduodenectomy: A Prospective Cohort Study.
Source:J Am Coll Surg; 225(4):498-507, 2017 Oct.
ISSN:1879-1190
Country of publication:United States
Language:eng
Abstract:BACKGROUND: Delayed gastric emptying (DGE) is a common serious problem after pancreaticoduodenectomy (PD). Flange gastrojejunostomy (FL-GE) is a previously described technique that creates an internal flange in a hand-sewn gastroenterostomy. Results of FL-GE on incidence and severity of DGE after PD are presented. STUDY DESIGN: Data were extracted from a prospective database of PD. Standard PD with antrectomy were performed with flange gastroenterostomy (FL-GE) or other techniques (NonFL-GE) at a single institution. The International Study Group of Pancreatic Surgery (ISGPS) definition of DGE was used, and DGE severity was graded based on the ISGPS grading system and the Modified Accordion Grading System (MAGS). RESULTS: There were 215 standard PDs performed. Sixty-eight (32%) were FL-GE and 147 (68%) were NonFL-GE. Delayed gastric emptying rates in FL-GE and NonFL-GE were 9% and 23%, respectively (p = 0.012). Differences in severity of DGE were even more prominent: 29% of DGEs in the NonFL-GE group were ISGPS grade C vs 0% in FL-GE. Also, 35% of DGEs in the NonFL-GE group were MAGS 3 vs 0% in FL-GE. Because of some differences in sex and inflammatory complications between groups, a propensity score analysis was performed, creating 57 matched patients in the FL-GE and NonFL-GE groups. The incidence of DGE remained significantly different in the groups (5% in FL-GE vs 18% in NonFL-GE; p = 0.039). CONCLUSIONS: In this cohort study, the flange technique was associated with a marked reduction in the incidence of DGE after PD.
Publication type:JOURNAL ARTICLE


  3 / 2416 MEDLINE  
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PMID:28522789
Author:Bharathi RS
Address:Armed Forces Medical College, Department of Surgery, Pune, India.
Title:Efficacy of camera sleeve in conveyance of conduits.
Source:Pol Przegl Chir; 89(1):76-83, 2017 Feb 28.
ISSN:2299-2847
Country of publication:Poland
Language:eng
Abstract:BACKGROUND: Esophageal substitutes need conveyance from the abdomen into the neck for restoration of alimentary continuity. Reports suggest that the use of plastic camera sleeve may prove advantageous in restoring conveyance. This study aims to evaluate the practicability of this approach, specifically, in laparoscopy-assisted surgeries. METHODS: The efficacy of camera sleeve in conduit transposition was prospectively evaluated over 2 years. The following parameters were assessed: success/failure; time taken; blood loss; adequacy of length of the conduit delivered into the neck; conduit orientation; ease of procedure through different routes; conduit damage; complications; and drawbacks. RESULTS: The technique was used in 25 consecutive patients. Two ileo-colonic, 13 gastric, and 10 colonic conduits were transposed. Posterior mediastinal, retro-sternal, and ante-sternal routes were used in 15, 8, and 2 cases, respectively. There were no failures. The technique was easy to adopt. It added < 10 minutes to the procedure. It entailed no additional blood loss. Adequate length of the conduit was transposed into the neck, atraumatically. Conduits maintained their orientation without effort. Although no complications per se were associated with its use, extra conduit length became transposed into the neck, twice, necessitating its trimming/adjustment. In one case, traction suture became avulsed from the conduit, midway in the tunnel. This could easily be rectified by pulling out the sleeve from the neck, which brought up the conduit along with it, as desired. CONCLUSIONS: Use of camera sleeve proves efficacious in interposition of esophageal substitutes.
Publication type:JOURNAL ARTICLE


  4 / 2416 MEDLINE  
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PMID:28431531
Author:Kim JH; Jun KH; Chin HM
Address:Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Title:Short-term surgical outcomes of laparoscopy-assisted versus totally laparoscopic Billroth-II gastrectomy for gastric cancer: a matched-cohort study.
Source:BMC Surg; 17(1):45, 2017 Apr 21.
ISSN:1471-2482
Country of publication:England
Language:eng
Abstract:BACKGROUND: To evaluate feasibility and benefits of intracorporeal anastomosis, we compared short-term surgical outcomes between laparoscopy-assisted distal gastrectomy (LADG) and totally laparoscopic distal gastrectomy (TLDG) with Billroth-II (B-II) anastomosis for gastric cancer. METHODS: Sixty patients underwent attempted B-II TLDG from 2011 through 2013. Patients who underwent B-II LADG prior to 2011 were matched to TLDG cases for demographics, comorbidities, tumor characteristics, and TNM stage. Perioperative and short-term surgical outcomes were compared between the two groups. RESULTS: Clinicopathological characteristics of both groups were comparable. The B-II TLDG group had a shorter hospital stay (9.4 vs. 12.0 days, P = 0.038) and average incision size was smaller (3.5 vs. 5.4 cm, P = 0.030) than in the B-II LADG group. Anastomotic leakage was not recorded in either group, and there were no differences in the rates of perioperative complications and in inflammatory parameters between the two groups. CONCLUSIONS: This study suggests that B-II TLDG is feasible, compared to B-II LADG, and that it has several advantages over LADG, including a smaller incision, a shorter hospital stay, and more convenience during surgery. However, prospective randomized controlled studies are still needed to confirm that B-II TLDG can be used as a standard procedure for LDG.
Publication type:COMPARATIVE STUDY; JOURNAL ARTICLE


  5 / 2416 MEDLINE  
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PMID:28373777
Author:Shim EJ; Ahn SE; Lee DH; Park SJ; Kim YW
Address:Eun Jung Shim, Sung Eun Ahn, Dong Ho Lee, Seong Jin Park, Department of Radiology, Kyung Hee University Hospital, Graduate School, Kyung Hee University, Seoul 130-872, South Korea.
Title:Dynamic enhanced computed tomography imaging findings of an inflammatory fibroid polyp with massive fibrosis in the stomach.
Source:World J Gastroenterol; 23(11):2090-2094, 2017 Mar 21.
ISSN:2219-2840
Country of publication:United States
Language:eng
Abstract:Inflammatory fibroid polyp (IFP) is a rare benign lesion of the gastrointestinal tract. We report a case of computed tomography (CT) imaging finding of a gastric IFP with massive fibrosis. CT scans showed thickening of submucosal layer with overlying mucosal hyperenhancement in the gastric antrum. The submucosal layer showed increased enhancement on delayed phase imaging. An antrectomy with gastroduodenostomy was performed because gastric cancer was suspected, particularly signet ring cell carcinoma. The histopathological diagnosis was an IFP with massive fibrosis. The authors suggest that when the submucosal layer of the gastric wall is markedly thickened with delayed enhancement and preservation of the mucosal layer, an IFP with massive fibrosis should be considered in the differential diagnosis.
Publication type:CASE REPORTS; JOURNAL ARTICLE


  6 / 2416 MEDLINE  
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PMID:28320386
Author:Glowka TR; Webler M; Matthaei H; Schäfer N; Schmitz V; Kalff JC; Standop J; Manekeller S
Address:Department of Surgery, University of Bonn, Sigmund-Freud-Str. 25, 53105, Bonn, Germany. tim.glowka@ukb.uni-bonn.de.
Title:Delayed gastric emptying following pancreatoduodenectomy with alimentary reconstruction according to Roux-en-Y or Billroth-II.
Source:BMC Surg; 17(1):24, 2017 Mar 20.
ISSN:1471-2482
Country of publication:England
Language:eng
Abstract:BACKGROUND: Delayed gastric emptying (DGE) remains the most frequent complication following pancreatoduodenectomy (PD) with published incidences as high as 61%. The present study investigates the impact of bowel reconstruction techniques on DGE following classic PD (Whipple-Kausch procedure) with pancreatogastrostomy (PG). METHODS: We included 168 consecutive patients who underwent PD with PG with either Billroth II type (BII, n = 78) or Roux-en-Y type reconstruction (ReY, n = 90) between 2004 and 2015. Excluded were patients with conventional single loop reconstruction after pylorus preserving procedures. DGE was classified according to the 2007 International Study Group of Pancreatic Surgery definition. Patients were analyzed regarding severity of DGE, morbidity and mortality, length of hospital stay and demographic factors. RESULTS: No difference was observed between BII and ReY regarding frequency of DGE. Overall rate for clinically relevant DGE was 30% (ReY) and 26% (BII). BII and ReY did not differ in terms of demographics, morbidity or mortality. DGE significantly prolongs ICU (four vs. two days) and hospital stay (20.5 vs. 14.5 days). Risk factors for DGE development are advanced age, retrocolic reconstruction, postoperative hemorrhage and major complications. CONCLUSIONS: The occurrence of DGE can not be influenced by the type of alimentary reconstruction (ReY vs. BII) following classic PD with PG. Old age and major complications could be identified as important risk factors in multivariate analysis. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00011860 . Registered 14 March 2017.
Publication type:JOURNAL ARTICLE


  7 / 2416 MEDLINE  
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PMID:28225921
Author:Barreira MA; Siveira DG; Rocha HA; Moura LG; Mesquita CJ; Borges GC
Address:MD, General Surgeon, Hospital Universitário Walter Cantídio, Fortaleza-CE, Brazil. Conception and design of the study; technical procedures; acquisition, interpretation and analysis of data; manuscript preparation and writing.
Title:Model for simulated training of laparoscopic gastroenterostomy.
Source:Acta Cir Bras; 32(1):81-89, 2017 Jan.
ISSN:1678-2674
Country of publication:Brazil
Language:eng
Abstract:Purpose: : To develop a model of gastroenterostomy and to analyze the acquisition of skills after training by simulation. Methods: : Experimental longitudinal study and of a quantitative character. The sample consisted of twelve general surgery residents from four hospitals. The training consisted of making ten anastomoses divided equally into five sessions and it took place over a period of six weeks. The evaluation of the anastomoses considered the time and the analysis of the operative technique through the global evaluation scale Objective Structured Assessment of Technical Skills (OSATS). Results: : Residents showed a reduction in operative time and evolution in the surgical technique statistically significant (p<0.01). The correlation index of 0.545 and 0.497 showed a high linear correlation between time variables and OSATS. Conclusion: : The preparation of ten gastroenterostomies is an exercise capable of transferring basic and advanced skills in laparoscopy through a standardized training using synthetic organs and a simulator.
Publication type:JOURNAL ARTICLE


  8 / 2416 MEDLINE  
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PMID:28192804
Author:Tarantino I; Ligresti D; Barresi L; Curcio G; Granata A; Traina M
Address:Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy.
Title:One-step, exchange-free, single-balloon-assisted endoscopic ultrasound-guided gastroenterostomy with lumen-apposing metal stent in malignant gastric outlet obstruction.
Source:Endoscopy; 49(S 01):E92-E94, 2017 Feb.
ISSN:1438-8812
Country of publication:Germany
Language:eng
Publication type:CASE REPORTS; JOURNAL ARTICLE; VIDEO-AUDIO MEDIA


  9 / 2416 MEDLINE  
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PMID:28105624
Author:Gao B; Huang Q; Dong J
Address:Department of General Surgery, The First Hospital of Yulin, Yulin 719000, China.
Title:[Clinical research of delta-shaped anastomosis technology in laparoscopic distal gastrectomy and digestive tract reconstruction].
Source:Zhonghua Wei Chang Wai Ke Za Zhi; 20(1):73-78, 2017 Jan 25.
ISSN:1671-0274
Country of publication:China
Language:chi
Abstract:OBJECTIVE: To evaluate the feasibility and safety of the delta-shaped anastomosis in laparoscopic distal gastrectomy and digestive tract reconstruction. METHODS: Clinical data of 34 gastric cancer patients undergoing laparoscopic distal gastrectomy with the delta-shaped anastomosis for digestive tract reconstruction (delta-shaped group) and 83 gastric cancer patients undergoing laparoscopic distal gastrectomy with Billroth I( for digestive tract reconstruction (Billroth group) by same surgeon team from July 2013 to July 2015 at the Department of Digestive Surgery, Affiliated Tumor Hospital of Shanxi Medical University were retrospectively analyzed. Data of two groups were compared. RESULT: Age, gender, tumor stage were not significantly different between the two groups(all P>0.05). Operation time of the first 15 cases in delta-shaped group was longer than that in Billroth group [(254.7±35.4) min vs. (177.8±33.0) min, t=11.190, P=0.000], while after above 15 cases, the operation time of delta-shaped group was significantly shorter than that of Billroth group [(142.1±14.6) min vs. (177.8±33.0) min, t=-4.109, P=0.001]. Delta-shaped group had less blood loss during operation [(87.1±36.7) ml vs. (194.0±55.1) ml, t=-10.268, P=0.000], and shorter length of incision [(4.1±0.4) cm vs. (6.1±1.0) cm, t=-10.331, P=0.000] than Billroth group. Compared with Billroth group, delta-shaped group presented faster postoperative bowel function return [(2.8±0.6) d vs. (3.3±0.5) d, t=-3.755, P=0.000], earlier liquid food intake [(7.4±1.5) d vs. (8.1±1.7) d, t=-4.135, P=0.000], earlier ambulation [(4.0±1.6) d vs. (6.8±1.4) d, t=-7.197, P=0.000] and shorter postoperative hospital stay [(12.6±1.9) d vs.(13.6±2.0) d, t=-20.149, P=0.000]. Morbidity of postoperative complication was 5.9%(2/34) in delta-shaped group, including anastomotic fistula in 1 case and incision infection in 1 case, and 6.0%(5/83) in Billroth group, including anastomotic fistula, incision infection, anastomotic stricture and dumping syndrome, without significant difference(P>0.05). Difference value of total protein and albumin between pre-operation and post-operation, and average decreased value of total protein, albumin, body weight between pre-operation and postoperative 6-month were not significantly different between two groups(all P>0.05). As for patients with BMI > 25 kg/m , compared to Billroth group, delta-shaped group presented less blood loss during operation [(94.1±36.7) ml vs. (203.0±55.1) ml, t=-10.268, P=0.000], lower injective dosage of postoperative analgesics [(1.9±1.1) ampule vs.(3.3±2.0) ampule, t=-2.188, P=0.032], faster intestinal recovery [(2.9±0.7) d vs. (3.2±0.9) d, t=-3.755, P=0.009], shorter hospital stay [(10.5±1.2) d vs. (11.7±1.5) d, t=-2.026, P=0.004], and lower morbidity of postoperative complication [7.1%(1/14) vs. 13.6%(3/22), χ =4.066, P=0.031]. CONCLUSION: In laparoscopic distal gastrectomy and digestive tract reconstruction, the delta-shaped anastomosis is safe and feasible, especially suitable for obese patients.
Publication type:JOURNAL ARTICLE


  10 / 2416 MEDLINE  
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PMID:27995467
Author:Omori T; Tokushige K; Kinoshita F; Ito A; Taniai M; Taneichi M; Iizuka B; Itabashi M; Nagashima Y; Yamamoto M; Nakamura S; Hashimoto E
Address:Institute of Gastroenterology Internal Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan. tohmori@ige.twmu.ac.jp.
Title:A case of gastrojejunocolic fistula with steatohepatitis.
Source:Clin J Gastroenterol; 10(1):23-31, 2017 Feb.
ISSN:1865-7265
Country of publication:Japan
Language:eng
Abstract:A man in his 30s, who had undergone retrocolic Billroth II reconstruction for perforated duodenal ulcer, presented with watery diarrhea for 2 years and suspected fatty liver. He was referred to our hospital for management of chronic diarrhea, weight loss, hepatopathy and hypoalbuminemia. Initial upper and lower gastrointestinal endoscopies were negative. Since a small bowel lesion was suspected, peroral single-balloon enteroscopy was performed, which identified feces-like residue near the Billroth II anastomotic site and a connection to the colon separate from the afferent and efferent loops. Transanal single-balloon enteroscopy identified a fistula between the gastrojejunal anastomosis and transverse colon, with the scope reaching the stomach transanally. Barium enema confirmed flow of contrast medium from the transverse colon through the fistula to the anastomotic site, allowing the diagnosis of gastrojejunocolic fistula. Liver biopsy showed relatively severe steatohepatitis (Brunt's classification: stage 2-3, grade 3). Resection of the anastomotic site and partial transverse colectomy were performed to remove the fistula, followed by Roux-en-Y reconstruction. Postoperatively, watery diarrhea resolved and the stools became normal. Hepatopathy and hypoproteinemia improved. One year later, liver biopsy showed marked improvement of steatosis. This case demonstrated marked improvement of both diarrhea/nutritional status and steatohepatitis after treatment of gastrojejunocolic fistula, suggesting that the fistula caused non-alcoholic steatohepatitis.
Publication type:CASE REPORTS; JOURNAL ARTICLE



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