Laparoscopic Reinforcement Suture (LARS) on Staple Line of Duodenal Stump Using Barbed Suture in Laparoscopic Gastrectomy for Gastric Cancer: a Prospective Single Arm Phase II Study

Kim, Min Chan; Kim, SangYun; Kim, Kwan Woo

doi:10.5230/jgc.2017.17.e40

Cited by 15 publications

(17 citation statements)

References 27 publications

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“…Some studies underlined the importance of suture line reinforcement in DSF prevention [2]. In a recent prospective phase II study, Kim et al highlighted DSF absence in 100 patients undergoing laparoscopic reinforcement suture (LARS) with barbed suture during laparoscopic gastrectomy for gastric cancer [24]. Other authors suggested application of coated sutures, fibrin glues or resorbable reinforcements [2].…”

Section: Discussionmentioning

confidence: 99%

Management of duodenal stump fistula after gastrectomy for malignant disease: a systematic review of the literature

Zizzo

Ugoletti²,

Manzini³

et al. 2019

BMC Surg

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Background Duodenal stump fistula (DSF) remains one of the most serious complications following subtotal or total gastrectomy, as it endangers patient’s life. DSF is related to high mortality (16–20%) and morbidity (75%) rates. DSF-related morbidity always leads to longer hospitalization times due to medical and surgical complications such as wound infections, intra-abdominal abscesses, intra-abdominal bleeding, acute pancreatitis, acute cholecystitis, severe malnutrition, fluids and electrolytes disorders, diffuse peritonitis, and pneumonia. Our systematic review aimed at improving our understanding of such surgical complication, focusing on nonsurgical and surgical DSF management in patients undergoing gastric resection for gastric cancer. Methods We performed a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guidelines. PubMed/MEDLINE, EMBASE, Scopus, Cochrane Library and Web of Science databases were used to search all related literature. Results The 20 included articles covered an approximately 40 years-study period (1979–2017), with a total 294 patient population. DSF diagnosis occurred between the fifth and tenth postoperative day. Main DSF-related complications were sepsis, abdominal abscess, wound infection, pneumonia, and intra-abdominal bleeding. DSF treatment was divided into four categories: conservative (101 cases), endoscopic (4 cases), percutaneous (82 cases), and surgical (157 cases). Length of hospitalization was 21–39 days, ranging from 1 to 1035 days. Healing time was 19–63 days, ranging from 1 to 1035 days. DSF-related mortality rate recorded 18.7%. Conclusions DSF is a rare but potentially lethal complication after gastrectomy for gastric cancer. Early DSF diagnosis is crucial in reducing DSF-related morbidity and mortality. Conservative and/or endoscopic/percutaneous treatments is/are the first choice. However, if the patient clinical condition worsens, surgery becomes mandatory and duodenostomy appears to be the most effective surgical procedure.

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Section: Discussionmentioning

confidence: 99%

Management of duodenal stump fistula after gastrectomy for malignant disease: a systematic review of the literature

Zizzo

Ugoletti²,

Manzini³

et al. 2019

BMC Surg

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“…In both groups, the mean numbers of LNs harvested were far exceeded the 15 LNs required by the guidelines [ 13 , 14 ] and the average numbers of LNs in the greater curvature and lesser curvature were (12.18 ± 6.55 vs. 13.62 ± 8.09, p = 0.444) and (19.55 ± 7.40 vs. 17.98 ± 8.31, p = 0.365) in SD and rEME group, respectively. The quality of lymph node dissection can be maintained in comparison with that in previous reports whether from the West or the East [ 15 , 25 – 27 ] which suggests that this procedure can provide pathologically reliable lymphadenectomy. By the anatomical sharp dissection tracing the reasonable plane and space, the average blood loss and duration of surgery were also similar to other studies from big centers [ 22 , 25 ].…”

Section: Discussionmentioning

confidence: 58%

“…The quality of lymph node dissection can be maintained in comparison with that in previous reports whether from the West or the East [ 15 , 25 – 27 ] which suggests that this procedure can provide pathologically reliable lymphadenectomy. By the anatomical sharp dissection tracing the reasonable plane and space, the average blood loss and duration of surgery were also similar to other studies from big centers [ 22 , 25 ]. Postoperative complications developed in seven patients (15.55%), including Clavien–Dindo classification of IIIb in two.…”

Section: Discussionmentioning

confidence: 58%

Modularized laparoscopic regional en bloc mesogastrium excision (rEME) based on membrane anatomy for distal gastric cancer

Shen

Dong

et al. 2018

Surg Endosc

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BackgroundThe purpose of the study was to evaluate the safety and feasibility of a new surgical procedure named modularized laparoscopic regional En bloc mesogastrium excision (rEME) based on the membrane anatomy in distal laparoscopic radical gastrectomy for gastric cancer.MethodsFrom January 2014 to June 2017, 92 consecutive cases of patients with stages I–III distal gastric cancer were divided into 2 groups: laparoscopic radical gastrectomy plus standard D2 lymph node dissection (SD group, n = 44) and modularized rEME (rEME group, n = 48). Evaluations were made in terms of the operative data, pathological results, recovery time of digestive tract functions, complications, and length of stay.Results85 patients (SD group, n = 40 and rEME group, n = 45) were finally included for analysis. There were no significant differences in the median total numbers of dissected LNs (31.98 ± 10.48 vs. 34.93 ± 13.12, p = 0.261), LNs in the greater curvature (12.18 ± 6.55 vs. 13.62 ± 8.09, p = 0.444), LNs in the lesser curvature (19.55 ± 7.40 vs. 17.98 ± 8.31, p = 0.365) between the SD and rEME groups. The rEME group showed lower loss of blood volume (107.11 ± 60.13 ml vs. 146.25 ± 85.78 ml, p = 0.019). No significant differences were found in recovery time of digestive tract functions, postoperative complication rates and length of hospital stay between the two groups.ConclusionLaparoscopic radical gastrectomy plus modularized rEME based on the membrane anatomy is a safe and feasible procedure for distal gastric cancer.

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“…Following a review and technical improvement, the stump was embedded, which allowed for a marked reduction in leakage from the duodenal stump. 18,19 . Interestingly, all duodenal stump leakage took place after total gastrectomy in our institution, no duodenal stump leakage occurred after distal gastrectomy, which may relate to some patients with distal gastrectomy using of a double cannula for preventive irrigation.…”

Section: Discussionmentioning

confidence: 99%

Modified Clavien-Dindo Classification to Analyze the Risk Factors of Early Complications after Radical Gastrectomy and the Impact of Complications on Long-Term Prognosis

Ma¹,

Wang²,

Yu³

et al. 2020

Preprint

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Background The modified Clavien-Dindo classification system was employed to investigate the occurrence of early complications along with the related risk factors following a radical gastrectomy procedure, with the view of conducting an analysis into the impact of complications on long-term prognosis. Methods The clinical data of 525 patients who had previously undergone a radical gastrectomy procedure for gastric cancer were analyzed in a retrospective fashion. Results Postoperative hospital stay: Complication group (17.88±8.472) days, severe complications group (23.10±7.594) days, significantly higher than non-complication group (10.26±1.973) days and non-severe complications group (11.47±4.712) days (P=0.000<0.05).Multivariate analysis: age (OR = 1.781, P = 0.013), preoperative comorbidity (OR = 1.765, P = 0.020), blood loss (OR = 2.153, P = 0.001), surgical approach (OR = 3.137, P = 0.000) were identified as an independent risk factor associated with early complications. Blood loss (OR=13.053, P=0.013), type of resection (OR=7.936, P=0.047) and nerve involvement (OR=3.670, P=0.009) were identified to be independent risk factors for severe complications.Severe postoperative complications (HR=1.595, P=0.107) and postoperative complications (HR=1.078, P=0.670) were not independent risk factors affecting the 5-year over survival rate. Conclusion Complications following radical gastrectomy were closely related to age, preoperative comorbidity, blood loss, and surgical approach; severe complications were closely related to blood loss, total gastrectomy, and nerve involvement; complications and severe complications were not found to be independent risk factors associated with long-term survival, that being said, they were significantly prolonged postoperative hospital stay.

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Laparoscopic Reinforcement Suture (LARS) on Staple Line of Duodenal Stump Using Barbed Suture in Laparoscopic Gastrectomy for Gastric Cancer: a Prospective Single Arm Phase II Study

Cited by 15 publications

References 27 publications

Management of duodenal stump fistula after gastrectomy for malignant disease: a systematic review of the literature

Management of duodenal stump fistula after gastrectomy for malignant disease: a systematic review of the literature

Modularized laparoscopic regional en bloc mesogastrium excision (rEME) based on membrane anatomy for distal gastric cancer

Modified Clavien-Dindo Classification to Analyze the Risk Factors of Early Complications after Radical Gastrectomy and the Impact of Complications on Long-Term Prognosis

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