Early postoperative anastomotic hemorrhage after gastrectomy for gastric cancer

Takeda, Yutaka; Bando, Etsuro; Kawamura, Taiichi; Tokunaga, Masanori; Ono, Hiroyuki; Terashima, Masanori

doi:10.1007/s10120-009-0535-6

Cited by 34 publications

(30 citation statements)

References 27 publications

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“…Although anastomotic bleeding may spontaneously stop, endoscopic hemostasis (endoclip, heater probe, or HSE injection) is required in cases with continuous bleeding or in those manifesting hypotension or tachycardia. Blood transfusion or re‐surgery may be required if endoscopic hemostasis is unsuccessful or if the bleeding site cannot be reached by endoscopy. After endoscopic hemostasis, attention should be paid to any sign of perforation or intraperitoneal abscess …”

Section: Management Of Patients With Non‐variceal Upper Gastrointestimentioning

confidence: 99%

Guidelines for endoscopic management of non‐variceal upper gastrointestinal bleeding

Fujishiro

Iguchi

Kakushima

et al. 2016

Digestive Endoscopy

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Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non‐variceal upper gastrointestinal bleeding using evidence‐based methods. The major cause of non‐variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug‐related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)‐related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance. As for treatment, endoscopic hemostasis, in which there are a variety of methods, is considered to be the first‐line treatment for bleeding from almost all causes. It is very important to precisely evaluate the severity of the patient's condition and stabilize the patient's vital signs with intensive care for successful endoscopic hemostasis. Additionally, use of antisecretory agents is recommended to prevent rebleeding after endoscopic hemostasis, especially for gastroduodenal ulcer bleeding. Eighteen statements with evidence and recommendation levels have been made by the JGES committee of these guidelines according to evidence obtained from clinical research studies. However, some of the statements that are supported by a low level of evidence must be confirmed by further clinical research.

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Section: Management Of Patients With Non‐variceal Upper Gastrointestimentioning

confidence: 99%

Guidelines for endoscopic management of non‐variceal upper gastrointestinal bleeding

Fujishiro

Iguchi

Kakushima

et al. 2016

Digestive Endoscopy

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“…However, despite efforts to prevent postoperative bleeding, unwanted bleeding does occur. Due to continuous improvement in hemostatic techniques, nonetheless, the incidence of postoperative bleeding has decreased, with significant events reported in less than 1% of surgeries 567…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Oxidized Regenerated Cellulose, SurgiGuard®, in Porcine Surgery

Kim

Yoon³

et al. 2017

Yonsei Med J

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PurposeAdequate hemostasis is important for postoperative outcomes of abdominal surgery. This study evaluated the hemostatic effects and accompanying histopathological changes of a novel oxidized regenerated cellulose, SurgiGuard®, during abdominal surgery.Materials and MethodsTen pigs underwent wedge resection of the spleen (1×1 cm) and liver (1.5×1.5 cm). The resected surface was covered with Surgicel® fabric or fibril type (Group A) or SurgiGuard® fabric or fibril type (Group B). Surgicel® and SurgiGuard® were randomized for attachment to the resected surface by fabric type (n=5) or fibril type (n=5). Blood loss was measured 5, 7, and 9 min after resection. Pigs were necropsied 6 weeks postoperatively to evaluate gross and histopathological changes.ResultsThere was no significant difference in total blood loss between groups [spleen fabric: Group A vs. Group B, 4.38 g (2.74–6.43) vs. 3.41 g (2.46–4.65), p=0.436; spleen fibril: Group A vs. Group B, 3.44 g (2.82–6.07) vs. 3.60 g (2.03–6.09), p=0.971; liver fabric: Group A vs. Group B, 4.51 g (2.67–10.61) vs. 6.93 g (3.09–9.95), p=0.796; liver fibril: Group A vs. Group B, 3.32 g (2.50–8.78) vs. 3.70 g (2.32–5.84), p=0.971]. Histopathological analysis revealed no significant difference in toxicities related to Surgicel® or SurgiGuard® [inflammation, fibrosis, foreign bodies, and hemorrhage (spleen: p=0.333, 0.127, 0.751, and 1.000; liver: p=0.155, 0.751, 1.000, and 1.000, respectively)].ConclusionSurgiGuard® is as effective and non-toxic as Surgicel® in achieving hemostasis after porcine abdominal surgery.

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“…15 Conversely, the development of anastomotic bleeding after using a circular stapler was reported to occur in 0.8% of cases after open distal gastrectomy. 22 No anastomotic bleeding was observed after conventional LADG in our previous study. 18 Nevertheless, it is necessary to determine ways to prevent this complication.…”

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confidence: 64%

“…Endoscopy has also been reported to be useful for both the confirmation of bleeding and therapeutic intervention. 22 At present, a linear stapler is commonly used for the remnant stomach-jejunum anastomosis after LADG. Noshiro et al reported that a linear stapler is applicable for reconstruction of a very small remnant stomach and jejunum by constructing an anastomotic site at the transected line of the stomach.…”

mentioning

confidence: 99%

Feasibility and Safety of Laparoscopy-Assisted Subtotal Gastrectomy for Gastric Cancer Invading the Upper Stomach

Wakasugi

Cho

Sato

et al. 2016

International Surgery

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This study evaluated the feasibility and safety of laparoscopy-assisted subtotal gastrectomy preserving a minimal remnant stomach for clinical T1 gastric cancer invading the upper stomach. Forty-three consecutive patients who underwent laparoscopy-assisted subtotal gastrectomy preserving a minimal remnant stomach were examined. In addition to the conventional laparoscopy-assisted distal gastrectomy, some short and posterior gastric arteries were resected. A minimal remnant stomach-jejunum anastomosis was made by using a circular stapler with regular anvil or transoral anvil. Transoral anvil was selected in 19 patients, and regular anvil was used in 24 patients. The median operation time was 288 minutes, and the median blood loss was 50 mL. Conversion to open surgery was required in 2 patients due to bleeding. No patient required conversion to open surgery due to the difficulty of the anastomosis. Nine patients developed postoperative complications, including grade 3 duodenal stump leakage in 1 patient and grade 2 anastomotic bleeding in another patient. No mortality was observed. Laparoscopy-assisted subtotal gastrectomy preserving a minimal remnant stomach is safe and feasible for early gastric cancer invading the upper stomach.

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Early postoperative anastomotic hemorrhage after gastrectomy for gastric cancer

Cited by 34 publications

References 27 publications

Guidelines for endoscopic management of non‐variceal upper gastrointestinal bleeding

Guidelines for endoscopic management of non‐variceal upper gastrointestinal bleeding

Efficacy of Oxidized Regenerated Cellulose, SurgiGuard®, in Porcine Surgery

Feasibility and Safety of Laparoscopy-Assisted Subtotal Gastrectomy for Gastric Cancer Invading the Upper Stomach

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