Laparoscopic reinforcement suture on staple-line of duodenal stump using barbed suture during laparoscopic gastrectomy for gastric cancer

Kim, SangYun; Nam, So Hyun; Min, Jae Seok; Kim, Min Chan

doi:10.4174/astr.2017.93.6.305

Cited by 9 publications

(13 citation statements)

References 20 publications

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“…The LRS method and single purse-string sutures [33]spent approximately equal time on the reinforcement of the duodenal stump. Besides, it was approximately the average time of reinforcement of duodenal stump, including barbed suture [34], lambert suture [35], and two half-purse-string sutures [36]. However, these methods require multiple stitches and knots, which is rather difficult for inexperienced surgeons.…”

Section: Discussionmentioning

confidence: 99%

The Feasibility and Safety of Barbed Running Suture in Total Laparoscopic Distal Gastrectomy (TLDG)for Gastric Cancer

Liu

Wang

Zhao

et al. 2020

Preprint

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Background: Totally laparoscopic distal gastrectomy (TLDG) is a minimally invasive method for gastric cancer. Intracorporeal reconstruction of the digestive tract with technically challenging is a critical step. Objective: This study aimed to evaluate the feasibility and efficacy of a simplified method using a unidirectional barbed suture to create a continuous hand-sewn for gastrointestinal enterotomy closure and reinforcement of the duodenal stump (RDS) in our institutional experience. Methods: From March 2019 to December 2019, 32 patients who underwent TLDG with a hand-sewn gastrojejunostomy (GJA), jejunojejunostomy (JJ) and reinforcement the duodenal stump (RDS) were enrolled in this study. After tumor resection, the technique with the knotless unidirectional barbed suture was used to close the common incision for the linear stapler during the intracorporeal reconstruction following the TLDG. Patient characteristics, operative time, length of hospital stay, the time of the first flatus, and postoperative complications were evaluated. Results: The reinforcement and closure method were successfully performed after TLDG in the 32 patients without re-exploration. No major adverse events occurred during or after the operation. The mean procedure time was (247.3 ± 44.2) min, while the common incision closure procedure took a mean of 9.5±1.6min, the Laparoscopic Reinforcement Suture (LRS) procedure took a mean of 5.7± 0.9min, the blood loss was (68.0 ± 48.3) ml. The mean number of LNs dissected was (31.5 ± 11.3), the mean time of the first flatus was (3.7±1.2) days, the postoperative bed activity time (1.7±0.3)days, and the mean postoperative hospital stay was(9.5±2.7)days. The complications rate was 6.3%, including one emptying dysfunction, and one local abscess near duodenal stumps. Conclusions: The use of the unidirectional absorbable barbed suture for gastrojejunal/ jejunojejunal enterotomy closure and reinforcement of the duodenal stump is safe and effective in TLDG.

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Section: Discussionmentioning

confidence: 99%

The Feasibility and Safety of Barbed Running Suture in Total Laparoscopic Distal Gastrectomy (TLDG)for Gastric Cancer

Liu

Wang

Zhao

et al. 2020

Preprint

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“…In addition, the surgical techniques and many other local factors, including the insufficient blood supply, the tissue vulnerability, such as local edema and scar on duodenal wall, the length of duodenal stump, and high pressure inside duodenal cavity might influence the healing of duodenal stump and result in DSL (6). So, in order to prevent DSL, reinforcement of duodenal stump is necessary and some reinforcement methods have been applied widely, including barbed suture (12), Lembert suture (13), two half-purse-string sutures (14). However, these methods require multiple stitches and knots, which is rather different for the unexperienced surgeons (12–14).…”

Section: Discussionmentioning

confidence: 99%

“…So, in order to prevent DSL, reinforcement of duodenal stump is necessary and some reinforcement methods have been applied widely, including barbed suture (12), Lembert suture (13), two half-purse-string sutures (14). However, these methods require multiple stitches and knots, which is rather different for the unexperienced surgeons (12–14). This study was a retrospective, one-arm clinical trial focusing on a new maneuver, single purse-string suture, for reinforcement of duodenal stump in patients harboring gastric adenocarcinoma following laparoscopic radical gastrectomy with Roux-en-Y or BillrothIIreconstruction.…”

Section: Discussionmentioning

confidence: 99%

“…Many literatures have proved the effectiveness of reinforcement of duodenal stump in laparoscopic gastrectomy with different methods. Sang Yun Kim proved that laparoscopic reinforcement suture on staple-line of duodenal stump using barbed suture can be considered as one of prevention methods of DSL during laparoscopic gastrectomy for gastric cancer (12). Inoue et al demonstrated the effectiveness of intracorporeal Lembert's sutures in laparoscopic distal gastrectomy receiving Roux-en-Y reconstruction while with no postoperative DSL in 223 patients (13).…”

Section: Discussionmentioning

confidence: 99%

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Single Purse-String Suture for Reinforcement of Duodenal Stump During Laparoscopic Radical Gastrectomy for Gastric Cancer

et al. 2019

Front. Oncol.

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Background: Duodenal stump leakage (DSL) is a serious surgical complication after radical gastrectomy with Roux-en-Y or BillrothII reconstruction. This study was designed to evaluate the effectiveness of laparoscopic single purse-string suture for reinforcement of duodenal stump.Methods: A total of 183 patients harboring gastric adenocarcinoma following laparoscopic radical gastrectomy with Roux-en-Y or BillrothIIreconstruction and single purse-string suture for reinforcement of duodenal stump were retrospectively enrolled from Zhongshan Hospital of Fudan University (Shanghai, China) between January 2014 and December 2016. Operative variables and short-term complications were documented and analyzed. Clavien-Dindo classification system was used to identify surgical complications.Results: Among 183 patients, 108 (59.02%) patients received distal gastrectomy and 75 (40.98%) received total gastrectomy. 88 (48.09%) patients underwent Roux-en-Y reconstruction and 95 (51.91%) patients underwent Billroth-II reconstruction. The mean time of laparoscopic single purse-string suture was 5.01 ± 1.33 min (range from 3.6 to 10.2 min). Postoperative early complication occurred in 26 cases of the patients. There were 4 cases of system-related complications (2.19%), including 3 cases of pulmonary infection (1.64%) and 1 cases of cardiovascular event (0.55%); and 22 cases of surgery-related complications (12.02%), including 6 cases of intra-abdominal infection (3.28%), 4 cases of pancreatic leakage (2.19%), 4 cases of wound complications (2.19%), 3 cases of gastroparesis (1.64%), 2 cases of intra-abdominal bleeding (1.09%), 2 cases of ileus (1.09%), 1 cases of lymphatic leakage (0.55%), and no duodenal stump leakage.Conclusion: Reinforcement on duodenal stump using laparoscopic single purse-string suture during laparoscopic radical gastrectomy is simple and effective and could avoid the incidence of duodenal stump leakage to some extent.

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“…Additionally, the staple line of duodenal stump should be reinforced by intracorporeal suture to prevent the duodenal stump fistula. Recently, it is reported that the method using barbed suture can be performed in a short operation time without any technical difficulties [22] .…”

Section: Cutting the Duodenummentioning

confidence: 99%

Laparoscopic lymph nodes dissection for advanced gastric cancer: the current status and the perspective

Shimada¹,

Amaya²,

Munemoto³

et al. 2019

MIS

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The laparoscopic gastrectomy (LG) with D2 lymph node dissection (LND) for advanced gastric cancer (AGC) have been widely done. However, the applicability to more advanced disease is still under debate. Actually, there are a lot of technical demands against D2 LND for AGC, e.g., total omentectomy, splenic hilar node dissection, and the management for bulky lymph nodes, etc. Recently, extensive research has been gradually performed in the field of LG for AGC and demonstrated that LG for AGC is a safe and feasible procedure with better short-term outcomes compared with open gastrectomy. Also, large-scaled phase III trials are ongoing, and their long-term outcomes are awaited the publication in the near future. LG with D2 LND by expert surgeons under the cautious indications could be acceptable treatment for locally AGC. On the other hand, we should keep searching for solutions to the technical or oncological issues, and long-term outcome of phase III study should be warranted for standard treatment. Robotic surgery, LG following neoadjuvant chemotherapy, or conversion therapy using LG for several stage IV patients may help us clear the technical hurdles, and may show survival advantages in the future.

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Laparoscopic reinforcement suture on staple-line of duodenal stump using barbed suture during laparoscopic gastrectomy for gastric cancer

Cited by 9 publications

References 20 publications

The Feasibility and Safety of Barbed Running Suture in Total Laparoscopic Distal Gastrectomy (TLDG)for Gastric Cancer

The Feasibility and Safety of Barbed Running Suture in Total Laparoscopic Distal Gastrectomy (TLDG)for Gastric Cancer

Single Purse-String Suture for Reinforcement of Duodenal Stump During Laparoscopic Radical Gastrectomy for Gastric Cancer

Laparoscopic lymph nodes dissection for advanced gastric cancer: the current status and the perspective

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