An option for delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy for gastric�cancer: A single‑layer suturing technique for the stapler entry hole using knotless barbed sutures combined with the application of additional knotted sutures
| Autor: | Isao Kawai, Takaya Tokuhara, Eiji Nakata, Hirofumi Ueda, Toshiyuki Tenjo, Keisaku Kondo, Atsushi Tomioka |
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| Rok vydání: | 2017 |
| Předmět: |
Cancer Research
medicine.medical_specialty totally laparoscopic distal gastrectomy Anastomosis Gastroduodenostomy delta-shaped gastroduodenostomy 03 medical and health sciences 0302 clinical medicine Suture (anatomy) medicine business.industry gastric cancer Articles Anatomy Curvatures of the stomach Surgery surgical procedures operative barbed suture additional knotted suture Oncology Barbed suture Anastomotic leakage 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology business Laparoscopic distal gastrectomy Single layer |
| Zdroj: | Oncology Letters |
| ISSN: | 1792-1082 1792-1074 |
| DOI: | 10.3892/ol.2017.7306 |
| Popis: | We report an option for delta-shaped gastroduodenostomy in totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. We detail a single-layer suturing technique for the endoscopic linear stapler entry hole using knotless barbed sutures combined with the application of additional knotted sutures. From June 2013 to February 2017, we performed TLDG with delta-shaped gastroduodenostomy in 20 patients with gastric cancer. The linear stapler was closed and fired to attach the posterior walls of the remnant stomach and the duodenum together. After creating a good view of the greater curvature side of the entry hole for the stapler by retracting the knotted suture on the lesser curvature side toward the ventral side, we performed single-layer entire-thickness continuous suturing of this hole using a 15-cm-long barbed suture running from the greater curvature side to the lesser curvature side. We placed the second and third stitches between the seromuscular layer of the remnant stomach and the entire-thickness layer of the duodenum while suturing the duodenal mucosa as minutely as possible. In addition, we routinely added one or two entire-thickness knotted sutures at the site near the greater curvature side. We placed similar additional knotted sutures at the site with a broad pitch. TLDG with this reconstruction technique was successfully performed in all patients with no occurrences of anastomotic leakage or intraabdominal abscess around the anastomosis. It is suggested that this method can be one option for delta-shaped gastroduodenostomy in TLDG due to its cost-effectiveness and feasibility. |
| Databáze: | OpenAIRE |
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