Proctotomy leak following laparoscopic total gastrectomy with transrectal specimen extraction for gastric cancer: a case report
| Autor: | Yu Rong, Yanling Xu, Gang Yu, Song Wang, Haipeng Meng, Jinchao Liu, Hui Xu |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Leak medicine.medical_specialty RD1-811 medicine.medical_treatment Rectum Natural orifice specimen extraction 03 medical and health sciences 0302 clinical medicine Gastrectomy Stomach Neoplasms Biopsy Case report Medicine Humans Nose Proctotomy leak medicine.diagnostic_test business.industry Cancer General Medicine Middle Aged medicine.disease Colorectal surgery Surgery medicine.anatomical_structure 030220 oncology & carcinogenesis Laparoscopic gastrectomy 030211 gastroenterology & hepatology Laparoscopy Neoplasm Recurrence Local business Complication Gastric cancer |
| Zdroj: | BMC Surgery BMC Surgery, Vol 21, Iss 1, Pp 1-4 (2021) |
| ISSN: | 1471-2482 |
| Popis: | Background Despite increasing acceptance in colorectal surgery, natural orifice specimen extraction (NOSE) surgery for the treatment of gastric cancer is still in its infancy, especially via the transrectal approach, which was barely reported. So little is known about its complications. Here we report the first case of proctotomy leak after transrectal NOSE gastrectomy, and our experience in preventive interventions. Case presentation A 62-year-old male patient complaining of upper abdominal pain who underwent open distal gastrectomy for gastric cancer one year ago was diagnosed with recurrent gastric cancer by gastroscopic biopsy. We performed laparoscopic total gastrectomy with transrectal specimen extraction on the patient. The operation was completed in a total laparoscopic approach and the specimen was extracted through a 3 cm longitudinal incision in the anterior wall of the upper rectum, then interrupted sutures were used for full-thickness closure of the rectal incision. The operative time was 470 min and intra-operative blood loss was 100 mL. The postoperative pathological examination showed pT1bN0M0 gastric adenocarcinoma. The patient developed proctotomy leak on the 10th postoperative day. We analyzed the causes of this rare complication and put forward a series of technical improvements. After failure of conservative treatment, a diverting ileostomy was created and the patient eventually recovered. We successfully prevented proctotomy leak in the subsequent 20 transrectal NOSE gastrectomies using improved techniques. Conclusions Proctotomy leak after transrectal specimen extraction should be considered among the complications of NOSE surgery and can be prevented by technical precautions. |
| Databáze: | OpenAIRE |
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