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Intracorporeal hand-sewn anastomosis following pylorus-preserving gastrectomy: surgical technique and short-term surgical outcome

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Abstract

Background

Although several procedures for mechanical anastomosis have recently been reported, intracorporeal manually hand-sewn anastomosis for totally laparoscopic pylorus-preserving gastrectomy (TLPPG) is considered technically difficult. Here, we report a new technique for laparoscopic reconstruction using hand-sewn sutures.

Methods

Together with a proper lymphadenectomy, the stomach was detached and resected using separate two-layer incisions, similar to the original laparotomy method. An approximately 5-cm antral cuff was left in place. The essential concept of this new method was to align the anastomotic site by rotating each clamped gastric stump. This allowed us to perform a secure, hand-sewn, two-layer anastomosis successfully. The short-term surgical outcome after TLPPG was retrospectively compared with that for patients who underwent a conventional laparoscopy-assisted procedure (LAPPG).

Results

Of the 20 consecutive patients who underwent pylorus-preserving gastrectomy in our department between 2014 and 2021, the first 8 patients and the subsequent 12 patients underwent LAPPG and TLPPG, respectively. The operation time was significantly longer in the TLPPG group (median, 302 vs. 269 min). The morbidity was comparable (8.3% in TLPPG vs. 12.5% in LAPPG). Postoperative delayed gastric emptying was only observed in one patient in the LAPPG group. TLPPG reduced the cost of the operation by reducing the number of linear stapler cartridges required.

Conclusion

A purely hand-sewn gastrogastrostomy is safe, feasible, and cost-effective, and it omits the need for a mini-laparotomy in the upper abdomen.

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Authors and Affiliations

  1. Department of Digestive Surgery, Niigata Cancer Center Hospital, 2-15-3, Kawagishicho, Niigata City, Niigata, 951-8566, Japan

    Masaki Aizawa, Hiroshi Yabusaki, Atsushi Matsuki, Takeo Bamba & Satoru Nakagawa

Authors
  1. Masaki Aizawa
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  2. Hiroshi Yabusaki
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  3. Atsushi Matsuki
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  4. Takeo Bamba
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  5. Satoru Nakagawa
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Contributions

Aizawa made substantial contributions to the conception and design, data analysis and interpretation, and article drafting. Matsuki and Bamba contributed to the acquisition of the data. Yabusaki participated in critically revising the article with regard to important intellectual content. Nakagawa approved the final version of the submitted manuscript.

Corresponding author

Correspondence to Masaki Aizawa.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. The study was conducted with the approval of our Institutional Review Board. Informed consent was replaced by an informed opt-out procedure because of the retrospective nature of the study and analysis used anonymous clinical data.

Sex-inclusive reporting: The subjects’ sex was not considered as a biologic variable in this work.

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The authors declare no competing interests.

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Aizawa, M., Yabusaki, H., Matsuki, A. et al. Intracorporeal hand-sewn anastomosis following pylorus-preserving gastrectomy: surgical technique and short-term surgical outcome. Langenbecks Arch Surg 407, 1711–1720 (2022). https://doi.org/10.1007/s00423-022-02575-9

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