Digestive Tract Haemorrhage Of Extraluminal Origin After Total Gastrectomy - Captain Three Leg* / Hy download full album zip cd mp3 vinyl flac
Small bowel obstructions SBOs are a known perioperative complication of laparoscopic Roux-en-Y gastric bypass and common etiologies include internal hernia, port site hernia, jejunojejunostomy stricture, ileus and adhesions.
Less commonly, SBO can be caused by superior mesenteric artery syndrome, intussusception and intraluminal blood clot.
We present a case of SBO caused by intraluminal blood clot from jejunojejunostomy staple line bleeding in a patient with a normal coagulation profile. Computed tomography was used to elucidate the cause of perioperative SBO, and diagnostic laparoscopy was used to both diagnose and treat the complication. In this case, the intraluminal clot was evacuated laparoscopically by enterotomy, thrombectomy and primary closure without anastomotic revision since there was no evidence of continued bleeding.
Administration of enoxaparin and Toradol post-operatively may have exacerbated mild intraluminal bleeding occurring at the stapled jejunojejunal anastomosis. Prompt recognition and treatment of perioperative SBO can prevent catastrophic consequences related to bowel perforation. Meta-analysis of hand-sewn versus mechanical gastrojejunal anastomosis during laparoscopic Roux-en-Y gastric bypass for morbid obesity. Apr There is no consensus on which technique used for One Foot Wrong - P!NK - Funhouse anastomosis is optimal.
The meta-analysis aimed to solve the issue by comparing hand-sewn with mechanical gastrojejunostomy during LRYGB for morbid obesity. Primary outcome was operation time. Secondary outcomes were postoperative complications anastomotic leak, stricture, bleeding, marginal ulcer and wound infectionpercent excess weight loss during one-year follow-up, reoperation, and postoperative hospital stay.
Odds ratios OR were calculated for dichotomous outcomes and mean differences MD for continuous outcomes. Results: Twelve trials were included comprising patients hand-sewn vs.
There was no difference in operation time when hand-sewn anastomosis was compared with mechanical gastrojejunostomy MD, - 6. Hand-sewn anastomosis had significantly lower incidence rate of postoperative bleeding OR, 0. And there were no significant differences in all the comparable outcomes between hand-sewn anastomosis and linear stapled anastomosis. Conclusions: This meta-analysis revealed no significant differences between mechanical and hand-sewn anastomosis except for greater incidence rates of postoperative bleeding and wound infection with the use of circular staplers.
Besides, more trials with adequate power are required and a cost analysis also worth trying. Jun Objective: To develop a new international classification of acute pancreatitis severity on the basis of a sound conceptual framework, comprehensive review of published evidence, and worldwide consultation.
Background: The Atlanta definitions of acute pancreatitis severity are ingrained in the lexicon of pancreatologists but suboptimal because these definitions are based on empiric description of occurrences that are merely associated with severity.
Methods: A personal invitation to contribute to the development of a new international classification of acute pancreatitis severity was sent to all surgeons, gastroenterologists, internists, intensivists, and radiologists who are currently active in clinical research on acute pancreatitis.
The invitation was not limited to members of certain associations Nelson Mandela - The Special AKA - Nelson Mandela residents of certain countries. A global Web-based survey was conducted and a dedicated international symposium was organized to bring contributors from different disciplines together and discuss the concept and definitions. Result: The new international classification is based on the actual local and systemic determinants of severity, rather than description of events that are correlated with severity.
The local determinant relates to whether there is peri pancreatic necrosis or not, and if present, whether it is sterile or infected. The systemic determinant relates to whether there is organ failure or not, and if present, whether it is transient or persistent.
The presence of one determinant can modify the effect of another such that the presence of both infected peri pancreatic necrosis and persistent organ failure have a greater effect on severity than either determinant alone.
The derivation of a classification based on the above principles results in 4 categories of severity-mild, moderate, severe, and critical. Conclusions: This classification is the result of a consultative process amongst pancreatologists from 49 countries spanning North America, South America, Europe, Asia, Oceania, and Africa.
It provides a set of concise up-to-date definitions of all the main entities pertinent to classifying the severity of acute pancreatitis in clinical practice and research. This ensures that the determinant-based classification can be used in a uniform manner throughout the world.
Unique patterns and proper management of post-gastrectomy bleeding in patients with gastric cancer. Background Bleeding after gastrectomy is a less frequent, but fatal complication. Since the pathophysiology and clinical manifestation differ considerably across cases, the exact outcome of postoperative bleeding is unclear.
This study aimed to improve management practices for postgastrectomy bleeding by the analysis of risk factors and clinical patterns.
Clinical data of the patients with postoperative bleeding were obtained from a prospectively established database, and risk factors for bleeding were analyzed using multivariate binary logistic regression. Results Incidence of the postoperative bleeding was 0. It was successfully managed with conservative treatment in 3 patients, endoscopic intervention in 2 and relaparotomy in the other 2 patients. Fifteen of them underwent radiologic intervention, and 4 of these patients were referred for surgery eventually.
Digestive Tract Haemorrhage Of Extraluminal Origin After Total Gastrectomy - Captain Three Leg* / Hy other 9 patients underwent relaparotomy as first-line treatment. Independent risk factors for the bleeding were male hazard ratio HR 2.
Conclusion Postgastrectomy bleeding can be managed properly considering its origin, severity, Cest Juste - Various - La Compil Vol.2 - 24 Hits Enchaînés, and the risk factors.
Blood clot obstruction of the jejunojejunostomy after laparoscopic gastric bypass. Background: Acute jejunojejunostomy JJ obstruction after laparoscopic gastric bypass secondary to the formation of an intraluminal blood clot is a rare event.
We analyzed our experience with such complications from a large consecutive patient series at a university hospital that is a referral center for bariatric surgery. Methods: A retrospective review of patient data in a register of all patients who had undergone gastric bypass from June to March was performed. Reoperations were analyzed for Trapped Under Ice - Metallica - Ride The Lightning cause and findings.
The patients received routine postoperative administration of low-molecular-weight heparin. Results: Of patients, 5. The indications for reoperation were signs of bleeding, nausea, or findings on abdominal computed tomography. The time of reoperation was 1, 1, 2, 3, and 11 days after the primary procedure. All patients underwent reoperation by laparoscopy, with evacuation of the blood clot through an opening of the suture or staple lines without additional revision of the JJ.
The gastric remnant was decompressed using a percutaneously placed gastrostomy tube. One patient had gastric leakage from the staple lines blowout that necessitated several later revisions for subcutaneous abscesses. Another patient developed acute pancreatitis. Conclusion: Blood clots can cause early obstruction of the JJ after gastric bypass. Awareness of this potentially rapidly progressive and life-threatening complication will allow immediate intervention and reduce the risk of serious sequelae.
Mar Surg Today. To promote proper management of postoperative bleeding, we investigated the clinical manifestations, predisposing factors, diagnostic approaches, and treatments of bleeding complications after gastric cancer surgery. Using a prospectively constructed database, we reviewed retrospectively 39 patients who suffered bleeding complications from among a total patients who underwent surgery for gastric cancer between and Operating time hazard ratio [HR] 1.
Luminal If You Wanna Party (Aladino Mix Edit) - Molella - If You Wanna Party occurred in 16 patients: as simple anastomosis site bleeding, treated successfully with conservative or endoscopic treatment, in 13; and as pseudoaneurysmal bleeding in 3, treated successfully with surgery in 2, but resulting in the death of 1.
Abdominal bleeding occurred in 23 patients, requiring surgery in TV Rock & Dj Chardy* - Gwens Escape / Monster and arterial embolization in 1. The most common finding at reoperation was bleeding from the mesocolon surface.
Postoperative bleeding can be managed successfully with a tailored approach, considering its origins and clinical manifestations.
Arterial pseudoaneurysms are a rare cause of luminal bleeding, but they can be fatal and should be suspected when extensive luminal bleeding presents after gastric cancer surgery. Takeshi Sano. Radical gastrectomy with regional lymphadenectomy is the only curative treatment option for gastric cancer. The extent of lymphadenectomy, however, is controversial.
The two European randomized trials only reported an increase in operative morbidity and mortality, but failed to show survival benefit, in the D2 lymphadenectomy group.
Only experienced surgeons in both procedures from 24 Japanese institutions participated in the study. Patients with potentially curable gastric adenocarcinoma T2-subserosa, T3, or T4 who were surgically fit were intraoperatively randomized. Postoperative morbidity and hospital mortality were recorded prospectively in a fixed format and were compared between the two groups in this study.
A total of patients were randomized between July and April Postoperative complications were reported in Although the morbidity for the extended surgery group Hospital mortality was reported at 0.
Specialized surgeons could safely perform gastrectomy with D2 lymphadenectomy in patients with low operative risks. Para-aortic lymphadenectomy could be added without increasing major surgical complications in this setting. Upper gastrointestinal hemorrhage UGIH is an infrequent complication The safety and efficacy of endoscopic management of immediate postoperative bleeding is unknown. All were found to have bleeding emanating from the gastrojejunostomy GJ staple line.
No patient required surgery to control hemorrhage. One patient aspirated during the endoscopic procedure with subsequent Digestive Tract Haemorrhage Of Extraluminal Origin After Total Gastrectomy - Captain Three Leg* / Hy encephalopathy and died 5 days postoperatively.
The mean length of stay was significantly longer in these patients 2. Current widespread application of laparoscopic techniques in Roux-en-Y gastric bypass RYGBP is making surgical safety an increasingly important issue.
We report one case that resulted in death due to postoperative fulminant acute pancreatitis after laparoscopic RYGBP was performed when this procedure was still relatively new in China. The patient was Wilderness - Steve Jolliffe - Warrior chronically obese year-old male.
Results After matching, data from patients in each group were analyzed. The incidence of EJS anastomotic stenosis during the first year after surgery was significantly lower in the LS group than in the CS group 1. The incidence of EJS leakage did not differ significantly between the groups 2. Conclusion The use of linear stapled reconstruction is safer than the use of circular stapled reconstruction for intracorporeal EJS in TLTG because of its lower risks of stenosis. The efficacies of various anastomosis methods have been studied   .
Although each method has been extensively investigated, relatively. Sep Purpose: No standard technique has been established for esophagojejunal anastomosis during laparoscopic total gastrectomy LTG for gastric cancer owing to the technical difficulty and high complication rate of this procedure.
This study was performed to compare the short-term outcomes of circular and linear stapling methods after LTG. The clinicopathological features and postoperative outcomes, including complications, were analyzed. Multivariate analysis was performed using a logistic regression model to identify the independent risk factors for anastomotic complications. Results: The incidence of anastomotic complications was significantly higher in group C than in group L The incidence of anastomosis 7.
Choral: Gloria Sei Dir Gesungen - J. S. Bach* / Karl Richter / Münchener Bach-Orchester / München did not differ between the groups 6. Conclusions: The overlap method was superior to the HDST with respect to anastomotic complications, especially anastomosis stricture. Early outcomes of laparoscopic total gastrectomy with hemi-double stapling technique in gastric cancer. Introduction: The most difficult step of laparoscopic total gastrectomy for gastric cancer is esophagojejunostomy anastomosis.
Although various techniques are recommended for this anastomosis, there is no standard method. This study aims to present the outcomes of our patients who underwent esophagojejunostomy using the hemi-double stapling technique HDST. Materials and Methods: Patients who had laparoscopic surgery due to gastric cancer in our hospital between October and May were retrospectively Digestive Tract Haemorrhage Of Extraluminal Origin After Total Gastrectomy - Captain Three Leg* / Hy. Patients who underwent laparoscopic total gastrectomy with HDST were included in this study.
Operative time, intraoperative blood loss, specimen extraction site, day of oral intake, length of stay, postoperative complications, and mortality were evaluated. Results: A total of 13 patients eight male, five female were included in this study. The mean age was Mean operative time was There were no complications Im Not A Loser - Judie Tzuke - Road Noise - The Official Bootleg to esophagojejunostomy.
A mean of Mean length of stay was Conclusion: HDST appears to be a safe method that can be used in the esophagojejunostomy step of laparoscopic total gastrectomy for gastric cancer. Next, all of the studies retrieved above were summarized according to the insertion site of the suture instrument, such as left upper, left lower, and umbilical Table 3. Then again, inappropriate reconstruction sometimes results in postoperative complications, some of which have recently been reported to correlate with poor long-term oncological out- come.
Current status of laparoscopic total gastrectomy. In this article, the current state of laparoscopic total gastrectomy LTG was reviewed, focusing on lymph node dissection and reconstruction. Lymph node dissection in LTG is technically similar to that in laparoscopic distal gastrectomy for early gastric cancer; however, LTG for advanced gastric cancer requires extended lymph node dissections including splenic hilar lymph nodes.
Although a recent randomized controlled trial clearly indicated no survival benefit in prophylactic splenectomy for lymph node dissection at the splenic hilum, some patients may receive prognostic benefit from adequate splenic hilar lymph node dissection.
Considering reconstruction, there are two major esophagojejunostomy EJS techniques, using a circular stapler CS or using a linear stapler LS. A few studies have shown that the LS method has fewer complications; however, almost all studies have reported that morbidity such as anastomotic leakage and stricture is not significantly different for the two methods.
As for CS, we grouped various studies addressing complications in LTG into categories according to the insertion procedure of the anvil and the insertion site in the abdominal wall for the CS. We compared the rate of complications, particularly for leakage and stricture. The rate of anastomotic leakage and stricture was the lowest when inserting the CS from the upper left abdomen and was significantly the highest when inserting the CS from the midline umbilical.
Scrupulous attention to EJS techniques is required by surgeons with a clear understanding of the advantages and disadvantages of each anastomotic device and approach. Background Early postoperative enteral nutrition is recommended for patients undergoing esophagectomy; however, the optimum method of tube feeding remains controversial.
Thus, the aim of this study is to assess two common enteral nutrition methods after minimally invasive McKeown esophagectomy. Methods A randomized controlled trial was performed with patients who underwent minimally invasive McKeown esophagectomy from January to December The patients were randomly divided so that 58 patients were in the jejunostomy feeding JF group and 62 patients were in the nasogastric feeding NF group.
The postoperative outcomes, including complications, nutritional status, quality of life, and survival rate, were studied and used as the main parameters to compare the abovementioned tube feeding methods. Conclusions Compared with NF, JF provides more safety, efficacy, and utility as nutritional support for minimally invasive McKeown esophagectomy patients who have a high incidence of anastomotic leakage.
However, the higher risk of intestinal obstruction after JF requires attention. Reverse puncture device technique: an innovation of esophagojejunostomy in radical laparoscopic total gastrectomy. Jul Future Oncol. Aim: To evaluate the feasibility, safety, short- and long-term efficacy of a reverse puncture device RPD technique for esophagojejunostomy in laparoscopic-assisted total gastrectomy.
Multivariate analysis showed that BMI odds ratio: 6. Conclusion: Laparoscopic-assisted total gastrectomy using an RPD technique is feasible, safe and effective. May Introduction A transorally inserted anvil has been developed to facilitate the creation of a stapled anastomosis without the need for a purse string to secure the anvil into Οι Ρίζες Μου - Θανάσης Βασιλόπουλος - Του Φεγγαριού Το Φως during laparoscopic total gastrectomy LTG.
We also describe the key technical details of the method. Results This method has been used in 53 patients thus far. The mean operative time was minutes, and the mean blood loss was mL.
The mean postoperative hospital stay was 18 days. There was no anastomotic leakage or stenosis. It can also product good outcomes. Esophagojejunal anastomotic leakage following gastrectomy for gastric cancer. Esophagojejunal anastomotic leakage EJAL is a serious complication of total or proximal gastrectomy for gastric cancer, with a reported incidence of 2. EJAL is an independent prognostic factor for the poor survival of gastric cancer patients.
Meticulous surgical techniques, experience with anastomotic devices, and a thorough understanding of various risk factors and preventive measures are essential and early diagnosis is critical for preventing EJAL-related death. Patients with suspected EJAL must be evaluated promptly, but contrast swallow is not recommended. There is no standard treatment strategy for EJAL, although conservative treatment with drainage and nutritional support is the most common approach.
Effective endoscopic treatments have been reported but need further validation. Surgical treatment is associated with high mortality but should be considered to prevent death from suboptimal EJAL management, for patients with severe sepsis or when conservative treatment has failed. Aug The surgeon inserted forceps while grasping the anvil from the right abdomen trocar.
Then, the circular stapler was held with the shaft convex. When the automated stapler and center rod were confirmed to be completely aligned, the anvil and the main unit were connected, and the device was fired.
Circular versus linear stapling in esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer: a propensity score-matched study. Noriaki Kyogoku.
PurposeWe used propensity score matching to compare the complication rates after laparoscopic total gastrectomy LTG with esophagojejunostomy EJS performed using a circular or a linear stapler. Patients were categorized into the circular and linear groups according to the stapler type used for the subsequent EJS.
Patients in the groups were matched using the following propensity score covariates: age, sex, body mass index, American Society of Anesthesiologists physical status, extent of lymph node dissection, and Japanese Classification of Gastric Carcinoma stage.
Clinicopathological characteristics and surgical outcomes were Marriage Madness - John Mayall - Back To The Roots. ResultsWe identified 66 propensity score-matched pairs among patients who underwent LTG.
There was no significant between-group difference in the median operative time, extent of lymph node dissection, number of lymph nodes resected, rate of conversion to open surgery, or number of surgeries performed by a surgeon certified by the Japanese Society of Endoscopic Surgery. Kun Yang. Side-to-side esophagojejunostomy during totally laparoscopic total gastrectomy for malignant disease: A multicenter study.
Oct Surg Endosc. Over the past few years, several techniques have been developed. This study aimed to evaluate the feasibility and surgical outcomes of the laparoscopic intracorporeal side-to-side EJS during TLTG used to treat malignant disease of the stomach. This study was conducted from June to December at three different institutions. Data were collected from patients' medical notes, and a database was established that recorded gender, age, American Society of Anesthesiology ASA classification, tumor site, operative duration, time required for anastomosis, length of hospital stay, morbidity, mortality, tumor node metastasis TNM staging, grading, type of procedure performed, type of lymphadenectomy, conversion rate, reason for conversion, histology type, reoperation rate, reason for reoperation, time required for closure of leak, flatus time, time enteral feeding started, morbidity, and mortality.
In this study, 56 totally laparoscopic gastrectomies TLGs The average operating time was min range, min. The average time required for both anastomoses was 44 min The conversion rate was The mean hospital stay was The mean time for closure of leaks was 12 days range, days.
There was one death 1. Laparoscopic intracorporeal side-to-side EJS is a safe and feasible technique. It represents a valid method for performing a reconstruction of the digestive tract in laparoscopic surgery after TLG, especially in presence of a narrow esophagus. All rights reserved. H Wang.
Wang H et al. The distance of proximal resection margin dose not significantly influence on the prognosis of gastric cancer patients after curative resection. Nov Purpose It is well known that the curative resection with an adequate proximal margin length is the most effective treatment in gastric cancer. However, despite surgeon's effort to achieve a sufficient proximal margin length, it is often difficult to obtain a recommended proximal margin length in some cases.
Therefore, this study was planned to investigate the impact of the length of proximal margin on prognosis of overall survival. Methods Between June and December1, gastric cancer patients who underwent gastrectomy with curative intent were reviewed.
According to tumor's location total vs. Also, the impact of the discrepancies of proximal margin length on local recurrence was assessed. Results The 5-year survival rate of positive proximal margin group was 5. In negative proximal margin groups, multivariate analysis showed that the discrepancies of proximal margin length have no impact on overall survival. Kaplan-Meier analyses showed that there is no association between discrepancy of proximal margin length and local recurrence.
Conclusion It takes effort to secure a negative proximal margin in the surgical treatment of gastric cancer because of the poor prognosis of positive proximal margin.
In negative proximal margin patients, there's no need to achieve an additional proximal margin length for long-term survival benefit because there was no impact of proximal margin length on overall survival and local recurrence. Improving the outcomes in gastric cancer surgery. Gastric cancer remains a significant health problem worldwide and surgery is currently the only potentially curative treatment option. Gastric cancer surgery is generally considered to be high risk surgery and five-year survival rates are poor, therefore a continuous strive to improve outcomes for these patients is warranted.
Fortunately, in the last decades several potential advances have been introduced that intervene at various stages of the treatment process. This review provides an overview of methods implemented in pre- intra- and postoperative stage of gastric cancer surgery to improve outcome.
Better preoperative risk assessment using comorbidity index e. Also preoperative optimization of patients using prehabilitation has future potential. Implementation of fast-track or enhanced recovery after surgery programs is showing promising results, although future studies have to determine what the exact optimal strategy is. Introduction of laparoscopic surgery has shown improvement of results as well as optimization of lymph node dissection.
Hyperthermic intraperitoneal chemotherapy has not shown to be beneficial in peritoneal metastatic disease thus far. Advances in postoperative care include optimal timing of oral diet, which has been shown to reduce hospital stay.
In general, hospital volume, i. In conclusion, progress has been made in improving the surgical treatment of gastric cancer. However, gastric cancer treatment is high risk surgery and many areas for future research remain. Laparoscopic total gastrectomy LTG is not a commonly performed procedure due to the difficulty associated with surgical reconstruction.
Between and June51 patients underwent laparoscopic gastrectomy with D2 lymph node dissection for gastric cancer. Short-term outcomes were compared between the two groups. There were no intraoperative complications or conversions to open surgery in any patients. Postoperative fluorography revealed no anastomosis leakage or stenosis in Stand Bye (Your Brother Man) (12 Mix) - Bryan* - Stand Bye (Your Brother Man) groups.
All patients resumed an oral liquid diet on postoperative day 5 and the mean postoperative hospital Water Ballet - Dan Gibson - Woodland Flute was 9 days. This technique may be considered a simple and time-saving alternative to the side-to-side linear esophagojejunostomy.
Critical factors that influence the early outcome of laparoscopic total gastrectomy. Background Laparoscopic distal gastrectomy LDG is a routinely performed procedure. However, clinical expertise in laparoscopic total gastrectomy LTG is insufficient, and it is only performed at specialized institutions. This study aimed to identify critical factors associated with complications after laparoscopic gastrectomy LGparticularly LTG.
Digestive Tract Haemorrhage Of Extraluminal Origin After Total Gastrectomy - Captain Three Leg* / Hy A large-scale database was used to identify critical factors influencing the early outcomes of LTG.
Predictive risk factors were determined by analyzing relationships between clinical characteristics and postoperative complications. Major complications after LTG were analyzed in detail. Major post-LTG complications included anastomotic leakages and pancreatic fistulae.
The rate of anastomotic leakage was significantly higher in the LTG group 5. Obesity was also associated with pancreatic fistula formation after LTG with pancreatosplenectomy. Advances in the surgical techniques associated with the LTG procedure will improve the Evelyn (Instrumental) - Waldo De Los Rios - ¿Quién Puede Matar A Un Niño? outcomes of esophagojejunostomy.
With regard to LTG-D2, establishing optimal and safe 10 node dissection is one of the most urgent issues. Pancreatic fistula after LTG with pancreatosplenectomy must be investigated in the future. Kazuya Muguruma. Abstract Laparoscopy-assisted total gastrectomy LATGesophagojejunostomy is an effective but difficult procedure to perform. We describe a simple modification that substantially facilitates insertion of the anvil into the esophagus and avoids oral injuries and complications.
After mobilization of the stomach and esophagus, a semicircumferential esophagotomy is made at the anterior esophageal wall. The suture is advanced anteriorly so that the center rod penetrates the esophageal wall.
The esophagus is transected with the stapler at this point. A circular-stapled esophagojejunostomy is then performed using the hemidouble stapling technique. Laparoscopy-assisted total gastrectomies were performed for 40 patients with gastric cancers T1N0M0. All procedures were completed laparoscopically without any complications.
The time required to place the anvil averaged 5 min compared with 9 min reported by others. There were no major complications or mortality in this series. The major advantage of this technique is that circular stapling is much easier than linear stapling, allowing surgeons without advanced surgical skills in LATG to perform the procedure effectively and safely. A safe anastomotic technique of using the transorally inserted anvil OrVil TM in Roux-en-Y reconstruction after laparoscopy-assisted total gastrectomy for proximal malignant tumors of the stomach.
Oct World J Surg Oncol. To explore the safety and feasibility of the transorally inserted anvil OrVilTM in laparoscopy-assisted total gastrectomy for gastric cancer. From December to Junea total of 28 patients underwent laparoscopy-assisted total gastrectomy with a Roux-en-Y-esophagojejunostomy anastomosis with OrVilTM.
Perioperative treatments, intraoperative data, postoperative complications and hospital length of stay were evaluated. There were no conversions to the open gastrectomy. The mean operation time was minutes and the mean blood loss was 70 ml. Patients resumed an oral liquid diet on postoperative days 4 to 5. The median hospital length of stay was 9. The median follow-up time was The use of the OrVilTM is technically feasible and relatively safe for Roux-en-Y reconstruction after laparoscopy-assisted total gastrectomy.
Jun In this study, a newly developed transoral pretilted circular anvil, a "the oral to the abdomen" method, was proven to be effective. The esophagus was transected and a small hole was then made in the esophageal stump through which the nasogastric tube of the OrVil was passed to insert the anvil into the abdominal cavity. After fixation with a stapler and a glove at the jejunal loop or the remnant stomach, the abdominal cavity was entered through the minilaparotomy.
Pneumoperitoneum and airtightness were reestablished after the glove edge was turned over to seal off the protector. Eventually, intracorporeal esophagojejunostomy or esophagogastrostomy was accomplished under the guidance of laparoscopy.
The surgical margins for all tumor patients were negative for tumor cells. The mean operative time was The 34 patients underwent successful laparoscopic surgeries with no open conversions. For 32 patients, there were no technological complications in the transoral insertion of the anvil to the esophageal stump.
There were no anastomotic leaks after the surgery. Apr Ann Surg Oncol. Introduction: Total gastrectomy TG is commonly performed for the treatment of patients with gastric cancer. Demographic, clinic, and perioperative data were obtained from a prospectively maintained database. Median age at resection was 64 years. Median body mass index was There were no deaths as a consequence of an EJ leak.
Conclusions: The use of the transoral anvil delivery system during EJ reconstruction is a safe and effective option for reconstruction after open or laparoscopic TG with acceptable mortality and morbidity.
The anastomotic leak rate appears to be comparable to that of other techniques. Comparison of short- and long-term outcomes of laparoscopic-assisted total gastrectomy and open total gastrectomy in gastric cancer patients. Mar Surg Endosc. Background: Laparoscopy-assisted total gastrectomy LATG has been used more frequently despite the associated technical difficulty and concerns over oncological safety. This study was undertaken to compare the short- and long-term surgical outcomes following either LATG or open total gastrectomy OTG for gastric cancer.
The most common complication after LATG was anastomotic-related complication 6. That after OTG was wound complication 3. Matched patients analysis: Time to first gas passing and time to the resumption of a soft diet were significantly shorter in the LATG group than in the OTG group. Among matched patients, there was no significant difference between complication rate 24 vs. During median follow-up of 50 range, months, there was no significant difference in the disease-free survival rate between the matched groups, respectively As for patients with TNM stage I gastric cancer, the disease-free survival rate vs.
Conclusions: LATG for gastric cancer has the advantage over an OTG in terms of better short-term outcomes and similar long-term outcome. Laparoscopy-assisted total gastrectomy with trans-orally inserted anvil OrVil TM : A single institution experience. To investigate the feasibility of laparoscopy-assisted total gastrectomy LATG using trans-orally inserted anvil OrVil TM in terms of operative characteristics and short term outcomes.
Among these patients, six were reconstructed by mini-laparotomy and 21 by OrVil TM. The clinicopathological characteristics, total operation time, total blood loss, abdominal incision and complications of anastomosis including stenosis and leakage, were compared between the groups undergoing LATG with OrVil TM and the group undergoing mini-laparotomy.
The operations were successfully performed on all the patients without intraoperative complications or conversion to open surgery. One case had hepatic metastatic carcinoma and 1 case had tumor recurrence near the anastomosis 8 mo after surgery.
The mean follow-up duration was 10 mo range, mo. Operation time was significantly reduced by the use of OrVil TM The postoperative course with regard to occurrence of stenosis and leakage was not different between the two groups. There were no significant differences in estimated blood loss. The upper abdominal incision was smaller in OrVil TM group than in mini-laparotomy group 4.
LATG using OrVil TM is a technically feasible surgical procedure with sufficient lymph node dissection, less operation time and acceptable morbidity. Various types of intracorporeal esophagojejunostomy after laparoscopic total gastrectomy for gastric cancer. Jung Ho Shim. Background Even for expert surgeons, esophagojejunostomy after laparoscopic total gastrectomy LTG is not always easy to perform.
Herein, we compare various types of esophagojejunostomy in terms of the technical aspects and postoperative outcomes. Methods A total of 48 patients underwent LTG for gastric cancer by the same surgeon.
We describe and review these types of esophagojejunostomy using a step-by-step approach. In terms of complications, there were five cases Conclusions To date, there are no reliable reconstruction methods after LTG. Therefore, special care is needed to prevent postoperative complication regardless of methods; also, technical innovations to support development of the safest methods of esophagojejunostomy are warranted.
Current status and evaluation of laparoscopic surgery for gastric cancer. Dec Dig Endosc. Laparoscopic gastrectomy for gastric cancer was developed in Japan and has been established as a treatment for early gastric cancer thanks not only to improvements in technology and medical equipment but also to great efforts made by surgeons.
With increasing numbers of surgeons performing the procedure and extending its indication to some advanced gastric cancers, it has achieved an important position in the treatment of gastric cancer together with endoscopic mucosal resection and open surgery. In clinical practice, it has been accepted as a safe, minimally invasive and radical treatment for early gastric cancer through several clinical studies and case—control studies.
A large-scale randomized controlled trial to evaluate laparoscopic gastrectomy as an acceptable procedure for early gastric cancer is being prepared. In order to extend the indication to some advanced gastric cancers, first, we need to collect more cases of laparoscopic gastrectomy for advanced cancer and start a phase II study in the experienced hospitals.
Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil OrVil after laparoscopic total gastrectomy. Background: Laparoscopic total gastrectomy LTG has not become as popular as laparoscopic distal gastrectomy LDG because of the more difficult reconstruction technique. Despite various modifications of reconstruction methods after LTG, an optimal procedure has yet to be established.
Methods: After full mobilization of the abdominal esophagus, the esophagus is transected with an endoscopic linear stapler. The anvil is then transorally inserted into the esophagus by using the OrVil system.
After jejunojejunostomy is performed through a 4-cm midline minilaparotomy, preparing a cm Roux-en-Y jejunal limb, a circular stapler is inserted into the jejunum and introduced into the abdominal cavity. Pneumoperitoneum is established by sealing Digestive Tract Haemorrhage Of Extraluminal Origin After Total Gastrectomy - Captain Three Leg* / Hy Quiet Nights Of Quiet Stars (Corcovado) - Kitty Kallen - The Kitty Kallen Story laparotomy wound retractor with a surgical glove attached to the circular stapler.
Double-stapling esophagojejunostomy with a circular stapler is performed intracorporeally, and the jejunal stump is closed with an endoscopic linear stapler. Results: Of the 16 patients who underwent this operation, there was no intraoperative complication or conversion to open surgery, and no patient required an extension of the initial incision for anastomosis. Mean operation time and blood loss were min and ml, respectively. One patient developed an intra-abdominal abscess postoperatively.
Postoperative fluorography revealed no anastomosis leakage or stenosis in any of the patients. Patients resumed an oral liquid diet on postoperative dayand the mean postoperative hospital stay was 11 days. Conclusions: We have successfully performed LTG with Roux-en-Y reconstruction using our technique in 16 patients without any anastomosis complications. We believe that our procedure is a secure and reliable reconstruction method after LTG, which is especially useful in obese patients, in whom conventional extracorporeal anastomosis often is difficult.
Systematic review of the predictors of positive margins in gastric cancer surgery and the effect on survival. Complete resection is the only definitive treatment available for gastric cancer. Factors associated with positive margins and their survival effects have been the subject of many studies, but the appropriate management for these patients is still debated.
The objective of this review is to examine positive margins after gastric cancer resections by exploring predictive factors, impact on survival, and optimal strategies for re-resection. Studies on gastric or gastroesophageal junction adenocarcinoma that either investigated the predictors for positive margin or employed multivariate methods to analyze the survival effects of positive margins were selected.
Twenty-two studies incorporating patients were included in this review. Positive margins were associated with larger tumor size, deeper wall penetration, more extensive gastric involvement, greater nodal involvement, higher stage, diffuse histology, higher Borrmann type, lymphatic vessel involvement, and total gastrectomy. Patient survival was independently associated with margin status, and this survival effect was more prominent in early cancers in most studies that performed subgroup Digestive Tract Haemorrhage Of Extraluminal Origin After Total Gastrectomy - Captain Three Leg* / Hy.
The probability of acquiring positive margins is highly dependent on the biology and the extent of the tumor. There is a significant negative effect on survival, which is more prominent in cancers at early stages, making re-resection or a second operation important. Patients with more advanced disease can be offered more extensive surgery to remove disease, but this should be balanced against the risks of more extensive resections.
Feb We report the method Dans LOesophage - Costes - Les Oxyures anastomosis based on a hemi-double stapling technique hereinafter, HDST using a trans-oral anvil delivery system EEA OrVil for reconstructing the Palermo Caves - Tot Taylor - The Shatterer (Original Soundtrack Album From The Motion Picture) and lifted jejunum following laparoscopic total gastrectomy or proximal gastric resection.
As a basic technique, end-to-side anastomosis was used for the La Ronde - Al Cohn And His Orchestra - Mr.
Music (Vinyl, Album) stump of the esophagus and lifted jejunum. After the gastric lymph node dissection, the esophagus was cut off obliquely to the long axis using an automated stapler. EEA OrVil was orally, and a small hole was created at the tip of the obliquely cut-off stump with scissors to let the valve tip pass through. When it was confirmed that the automated stapler and center rod were made completely linear, the anvil and the main unit were connected with each other and firing was carried out.
Then, HDST-based anastomosis was completed. The method may safe laparoscopic anastomosis between the esophagus and reconstructed intestine. Totally laparoscopic total gastrectomy for gastric cancer: Literature review and comparison of the procedure of esophagojejunostomy.
There has been a recent increase in the use of totally laparoscopic total gastrectomy TLTG for gastric cancer. However, there is no scientific evidence to determine which esophagojejunostomy EJS technique is the best.
In addition, both short- and long-term oncological results of TLTG are inconsistent. We reviewed 25 articles about TLTG for gastric cancer in which at least 10 cases were included.
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