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Easy fixation effects the prevention of Peterson’s hernia and Roux stasis syndrome

World Journal of Gastrointestinal Surgery 2020年第8期12卷 346-354页

作者： Jian-Zhong Wu Hajime Orita Shun Zhang Hiroyuki Egawa yukinori yube Sanae Kaji Shinichi Oka Tetsu Fukunaga Department of Gastroenterology and Minimally Invasive Surgery Juntendo University School of MedicineJuntendo UniversityTokyo 1638001Japan Department of Gastroenterology Surgery Suzhou Ninth People’s HospitalNantong UniversitySuzhou 215000Jiangsu ProvinceChina Department of Surgery Tongji UniversityShanghai 200000China

BACKGROUND Laparoscopic distal gastrectomy(LDG)for gastric cancer has been progressed and popular in Japan,since it was first described in *** reconstruction methods can be adopted according to remnant stomach size,and balance of pros and ***-en-Y(R-Y)reconstruction is a one of standard options after *** complications include Petersen’s hernia and Roux stasis *** we report our ingenious attempt,fixation of Roux limb and duodenal stump,for decreasing the development of Petersen’s hernia and Roux stasis *** To develop a method to decrease the development of Petersen’s hernia and Roux stasis *** We performed ante-colic R-Y reconstruction after *** R-Y reconstruction,we fixed Roux limb onto the duodenal stump in a smooth *** this small improvement in Roux limb,Roux limb was placed to the right of the ligament of *** not only changed the anatomy of the Petersen’s defect,but it also kept a fluent direction of gastrointestinal anastomosis and avoided a cross-angle after jejunojejunostomy.31 patients with gastric cancer was performed this technique after R-Y *** parameters including clinicopathologic characteristics,perioperative outcomes,postoperative complication and follow-up data were *** The operative time was(308.0±84.6 min).This improvement method took about 10 ***(6.5%)patients experienced pneumonia and pancreatitis,*** patient required reoperation or *** patients were followed up for at least 3 year,and none of the patients developed postoperative complications related to internal hernia or Roux stasis *** This 10 min technique is a very effective method to decrease the development of Petersen’s hernia and Roux stasis syndrome in patients who undergo LDG.

关键词： Laparoscopy distal gastrectomy Roux-en-Y reconstruction Internal hernia Roux limb syndrome Gastric cancer

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Effectiveness and safety of a laparoscopic training system combined with modified reconstruction techniques for total laparoscopic distal gastrectomy

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World Journal of Gastroenterology 2020年第13期26卷 1490-1500页

作者： Shun Zhang Hajime Orita Hiroyuki Egawa Ryota Matsui Suguru Yamauchi yukinori yube Sanae Kaji Toru Takahashi Shinichi Oka Noriyuki Inaki Tetsu Fukunaga Department of Gastroenterology and Minimally Invasive Surgery Juntendo University HospitalTokyo 113-8431Japan Department of Gastrointestinal Surgery Shanghai East HospitalTongji UniversityShanghai 200120China Department of Surgery Juntendo Urayasu HospitalJuntendo UniversityChiba 2790021Japan

BACKGROUND Total laparoscopic distal gastrectomy(TLDG)is increasing due to some advantages over open surgery,which has generated interest in gastrointestinal ***,TLDG is technically demanding especially for lymphadenectomy and gastrointestinal *** the course of training,trainee surgeons have less chances to perform open gastrectomy compared with that of senior *** To evaluate an appropriate,efficient and safe laparoscopic training procedures suitable for trainee *** Ninety-two consecutive patients with gastric cancer who underwent TLDG plus Billroth I reconstruction using an augmented rectangle technique and involving trainees were *** trainees were taught a laparoscopic view of surgical anatomy,standard operative procedures and practiced essential laparoscopic *** TLDG procedure was divided into regional lymph node dissections and gastrointestinal reconstruction for analyzing trainee *** surgical outcomes were compared between trainees and trainers to clarify the feasibility and safety of TLDG performed by *** curves were used to assess the utility of our training *** Five trainees performed a total of 52 TLDGs(56.5%),while 40 TLDGs were conducted by two trainers(43.5%).Except for depth of invasion and pathologic stage,there were no differences in clinicopathological *** performed more D2 gastrectomies than *** total operation time was significantly longer in the trainee *** time spent during the lesser curvature lymph node dissection and the Billroth I reconstruction were similar between the two *** difference was found in postoperative complications between the two *** learning curve of the trainees plateaued after five TLDG *** Preparing trainees with a laparoscopic view of surgical anatomy,standard operative procedures and practice in essential laparoscopic skills enabled trainees to perform TLDG sa

关键词： Gastric cancer Total laparoscopic gastrectomy Education system Trainees Augmented rectangle technique Standard procedure

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Long-term outcomes of postgastrectomy syndrome after total laparoscopic distal gastrectomy using the augmented rectangle technique

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World Journal of Gastrointestinal Surgery 2022年第2期14卷 120-131页

作者： Suguru Yamauchi Hajime Orita Jun Chen Hiroki Egawa Yutaro Yoshimoto Akira Kubota Ryota Matsui yukinori yube Sanae Kaji Shinichi Oka Malcolm V Brock Tetsu Fukunaga Department of Gastroenterology and Minimally Invasive Surgery Juntendo University HospitalTokyo 113-8431Japan Department of Surgery The Johns Hopkins University School of MedicineBaltimoreMD 21205-2196United States

BACKGROUND For total laparoscopic distal gastrectomies for gastric cancer,the reconstruction method is critical to the clinical outcome of the ***,which reconstruction technique is optimal remains *** originally reported the augmented rectangle technique(ART)as a reconstruction option for total laparoscopic Billroth I ***,little is known about its effect on long-term outcomes,specifically the incidence of postgastrectomy syndrome and its impact on quality of *** To analyze postgastrectomy syndrome and quality of life after ART using the Postgastrectomy Syndrome Assessment Scale-37(PGSAS-37)*** At Juntendo University,a total of 94 patients who underwent ART for Billroth I reconstruction with total laparoscopic distal gastrectomies for gastric cancer between July 2016 and March 2020 completed the PGSAS-37 *** analysis was performed,comparing those 94 ART cases from our institution(ART group)to 909 distal gastrectomy cases with a Billroth I reconstruction from other Japanese institutions who also completed the PGSAS-37 as part of a larger national database(PGSAS group).RESULTS Patients in the ART group had significantly better total symptom scores in all the symptom subscales(i.e.,esophageal reflux,abdominal pain,meal-related distress,indigestion,diarrhea,constipation,and dumping).The loss of body weight was marginally greater for those in the ART group than in the PGSAS group(-9.3%vs-7.9%,P=0.054).The ART group scored significantly lower in their dissatisfaction of ongoing symptoms,during meals,and with daily *** ART for Billroth I reconstruction provided beneficial long-term results for postgastrectomy syndrome and quality of life in patients undergoing total laparoscopic distal gastrectomies for gastric cancer.

关键词： Laparoscopic distal gastrectomy Postgastrectomy syndrome Augmented rectangle technique Billroth I Postgastrectomy Syndrome Assessment Scale-37

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