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Short-Term and Quality of Life Outcomes of Patients Using Linear or Circular Stapling in Esophagojejunostomy after Laparoscopic Total Gastrectomy

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Studies comparing the incidence of reflux esophagitis (RE) and patients’ quality of life (QoL) when using circular stapler (CS) and linear stapler (LS) in esophagojejunostomy (EJS) after laparoscopic total gastrectomy (LTG) are rare, and certainly there are not enough to make a definitive decision on best practice. Presented herein is a study on the comparison of the short-term outcomes, QoL of the patients with the focus on the incidence of RE after both linear and circular stapling in LTG.

Methods

From January 2014 to October 2018, 120 patients were analyzed; of these, 42 patients underwent laparoscopy-assisted total gastrectomy (LATG) with CS (CS group) and 78 patients who underwent totally laparoscopic total gastrectomy (TLTG) with LS (LS group). We examined the results obtained in terms of perioperative outcomes, reflux-related assessments (GerdQ questionnaire and endoscopy findings with all cases; 24-h pH monitoring with limited cases), and EORTC QLQ-C30 and QLQ-STO22. In addition, questionnaires were also supplied to patients and the results were recorded.

Results

The incidence of anastomotic stenosis (7.1% vs. 0; P < 0.05) and the median intraoperative blood loss (180.0 vs. 100.0 mL; P < 0.05) of the CS group were higher than the LS group. The factor aside, no significant differences were observed between the two groups with regard to the incidence of RE assessed by the QLQ-STO22 reflux scale, the GerdQ scores, endoscopy (in all cases), or the percent time of pH > 7 (in limited cases) (P > 0.05). In the EORTC QLQ-C30 and QLQ-STO22, it was noted that the score of constipation [0 (0, 0) vs. 0 (0, 33.3); P = 0.028] and postoperative dysphagia [0 (0, 0) vs. 0 (0, 22.2); P = 0.046] of the LS group in a 1-year follow-up were lower than the CS group.

Conclusions

TLTG with LS generated better results than LATG with CS in terms of the incidence of anastomotic stenosis, intraoperative blood loss, and postoperative constipation and dysphagia. Furthermore, when compared with circular stapling, linear stapling in EJS did not increase the incidence of RE assessed by the QLQ-STO22 reflux scale, the GerdQ scores, endoscopy (in all cases), or the percent time of pH > 7 (in limited cases).

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Contributions of each Co-Author

M.W.: conceived and drafted the manuscript; N.W. and Z.Y.: performed quality assessment and statistical analysis; T.W., S.Z., L.D., Z.Z., D.W., P.G., B.Z., Y.Y., G.J., and K.W.: performed data acquisition and reviewed the data; Q.Q. and X.H.: gave critical comments and revised the manuscript. All the authors were involved in the critical revision and final approval of the article.

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Author notes

  1. Mingguang Wei, Nan Wang, and Zhiyuan Yin contributed equally to this work as first authors.

Authors and Affiliations

  1. Department of General Surgery, The Second Affiliated Hospital of Air Force Medical University, Xinsi Road No.1, Baqiao District, Xi’an, 710038, China

    Mingguang Wei, Nan Wang, Zhiyuan Yin, Tao Wu, Shuai Zhou, Ling Dang, Zhansheng Zhang, Di Wu, Peng Gao, Bo Zhang, Ying Yang, Guozhan Jia, Ke Wang, Qing Qiao & Xianli He

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  1. Mingguang Wei
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Correspondence to Qing Qiao or Xianli He.

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Wei, M., Wang, N., Yin, Z. et al. Short-Term and Quality of Life Outcomes of Patients Using Linear or Circular Stapling in Esophagojejunostomy after Laparoscopic Total Gastrectomy. J Gastrointest Surg 25, 1667–1676 (2021). https://doi.org/10.1007/s11605-020-04806-0

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