Journal of Gastric Surgery
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Mannheim Peritonitis Index: usefulness in a context with limited resources: Prognosis of acute peritonitis.
No full textBackground:
The objective of this study is to evaluate the Mannheim Peritonitis Index (MPI) usefulness for acute generalized peritonitis management in a clinical limited resources context.
Methods:
This is a prospective study from 1 January to 31 October 2019 including patients admitted to a sub-saharan hospital for acute generalized peritonitis. Perioperative variables and outcomes were considered.
Results:
70 patients were included. Mean age was 32.6 ± 14.6 years with a sex ratio of 1.33. The mean time to patients’ hospital admission was 3.9 ± 2.1 days. Most patients had ileal and gastric perforations (27.1% and 18.6%). Twenty six patients (37.1%) developed complications and thirty-day mortality rate was 14.3%. Positive predictive value of MPI was 63.6% and negative predictive value was 83, 8%. Sensitivity of MPI ≥ 26 was 77.8%; Specificity of MPI < 25 was 72.1%.
Conclusion
This experience shows that MPI is a good predictor of morbidity and mortality for patients with acute peritonitis even in a difficult context with few resources and many patients. Identifying the most critical patients, a more careful surgical staff involvement may improve patients outcome
Superior Mesenteric Artery Syndrome: A Single-institution Experience
Full text linkBackground:Superior mesenteric artery syndrome (SMAS) is a rare disease in adult. SMAS is characterized by acute, or, more commonly, chronic nonspecific symptoms due to duodenal obstruction and severe malnutrition with reduced arterio-mesenteric angle and distance. Surgical treatment may be necessary in most cases with chronic symptoms or when conservative treatment fails in SMAS.Methods:A retrospective chart review was performed on patients who underwent operation for SMAS from January 2008 to August 2020 in Cardinal Tien Hospital. Patients’ clinical presentations, surgical intervention, and outcomes.Results:Data from a total of 14 patients diagnosed with SMAS were analyzed, of which seven were diagnosed with SMAS by abdominal computed tomography and upper gastrointestinal series with water-soluble barium contrast. Six of the confirmed cases underwent surgery, namely, gastric decompression using a nasogastric tube, andcorrection of electrolyte imbalance. The nasoduodenal tube was placed through the obstructed duodenum to provide a high-nutrient fluid supplement. After conservative treatment failure, the patients underwent surgery. Of the six patients, four underwent duodenojejunostomy, one underwent a mini-laparotomy duodenojejunostomy bypass, and the last one underwent Roux-en-Y duodenojejunal bypass with duodenal feeding tube insertion.Conclusion:Patients with SMAS should initially be treated conservative. Surgical intervention should be considered in patients in whom conservative treatments were not effective.Complete resolution of all symptoms may not always be guaranteed after surgical intervention. Laparoscopy is currently widely used. In well-selected patients, minimally invasive or mini-laparotomy duodenojejunostomy is a safe and effective treatment for SMAS. The main advantages of mini-laparotomy duodenojejunostomy over other surgical approaches include half-length surgical incision and a shorter operative time. Duodenojejunostomy is rapidly becoming the standard procedure of this condition, and it has excellent outcomes comparable with those of open surgery
Robotic surgery for gastric cancer: a review of the literature
Full text linkMinimally invasive surgery is increasing attention worldwide as an effective treatment approach in gastric cancer.In this context, several studies suggest that robotic technology may add some advantages over traditional laparoscopy, but the role of the robotic approach in the common surgical setting is still uncertain.The objective of this study is to review the current evidences in the literature comparing robotic surgery to other surgical approaches.Patients underwent robotic gastrectomy showed some benefits in terms of blood loss, postoperative morbidity, and length of hospital stay. No significant differences have been found in terms of survivals, while the number of lymph nodes retrieved with therobotic approach, expecially in the extraperigastric region, is generally higher than that of laparoscopy.The current studies in the literature suggest that the robotic gastrectomy is not inferior to the laparoscopic procedure and provides some surgical and clinical benefits
The role of gut microbiota: from gastrointestinal cancer to neurodegenerative diseases
Full text linkThe intestinal milieu harbours the gut microbiota, consisting of a complex community of bacteria, archaea, fungi, viruses and protozoans that bring to the host organism an endowment of cells and genes more numerous than its own. In recent years, an interest in intestinal microbiota-host interactions has increased due to many findings about the impact of gut bacteria on human health and disease. Gut microbiota dysbiosis, defined as marked alterations in the amount and function of the intestinal microorganisms, is correlated with the aetiology of chronic diseases, ranging from cardiovascular, neurologic, respiratory and metabolic illnesses to cancer. In this review, we focus on the interplay among gut microbiota and host to provide a perspective on the role of microbiota in the pathogenesis and progression of various human disorders, highlighting the influence of gut microbiota on cancers in the gastrointestinal tract and on neurodegenerative diseases
Routine Intra-Operative Esophagogastroduodenoscopy in 1727 patients
No full textBackground:
Routine esophagogastroduodenoscopy (EGD) before bariatric surgery remains controversial. This study was undertaken to determine the feasibility, safety, and effectiveness of routine intraoperative esophagogastroduodenoscopy (EGD) before bariatric surgery, the incidence of pathological EGD findings in patients undergoing bariatric surgery, the incidence of altered surgical plans because of the EGD findings, and to correlate patient symptoms with the EGD findings.
Methods:
This is a Prospective ongoing, interventional study that was started on March 1st, 2018 with this preliminary report covering the cases up to September 30th, 2019. Routine intraoperative pre-bariatric procedure EGD was done and findings recorded. Patients consented for the endoscopy and the possibility of altering the planned operation was discussed with the patient.
Results:
Routine intraoperative EGD was done on 1727 patients. Nine hundred twenty-two (53.4%) were female. Three hundred fifty-one (20.3%) patients had preoperative history of or symptoms of gastroesophageal reflux disease out of which 84(29%) had positive findings on endoscopy. One hundred twenty (6.9%) had esophagitis and only 22(18.3%) had symptoms of gastroesophageal reflux disease (GERD) preoperatively. Two hundred ninety (16.7%) had gastritis, 392(22.3%) had bile in stomach, 105(6.07%) had duodenitis and 50 (2.9%) had a hiatus hernia. Our primary plan of surgery was changed based on endoscopic findings in 47(2.7%) of patients.
Conclusion:
Intraoperative EGD is do-able, cost-effective, safe and convenient for both the patient and surgeon. We found asymptomatic significant upper gastrointestinal (UGI) pathologies that altered the planned procedure in 2.7% of the patients
Assessment of the Completeness of Lymph Node Dissection Using Indocyanine Green in Laparoscopic and Robotic Gastrectomy for Gastric Cancer – A Review
Full text linkMore recently, few scientists have attempted to figure out how to improve the careful recognizable proof of the lymphatic waste courses and lymph node stations during radical gastrectomy in this way beginning another examination outskirt in this field called "navigation surgery". Among the distinctive detailed arrangements, the presentation of the indocyanine green has drawn consideration for its attributes, a fluorescence colour that can be identified in the near-infrared spectral band. A fluorescence imaging innovation has been coordinated with frameworks of lymph node dissection in laparoscopic and robotic gastrectomy surgery for gastric cancer. Current confirmations uncover that ongoing vessel navigation by using indocyanine green fluorescence during laparoscopic gastrectomy was demonstrated doable with negligible complications. Its utilization may empower the presentation of fruitful robotic or laparoscopic pylorus-preserving gastrectomy with a decrease in unintended intraoperative wounds, for example, second rate polar dead tissue of the spleen during laparoscopic gastrectomy. The clinical ramifications of utilization of indocyanine green in laparoscopic and robotic gastrectomy for gastric cancer was, in any event, for surgeons with a significant level of involvement with laparoscopic D2 dissection, the near-infrared imaging framework can fill in as a complimentary apparatus to affirm total lymphatic node dissection in patients with atypical life structures. With some restrictions the incorporated innovation of indocyanine green fluorescence with near-infrared imaging systems was practical and a promising strategy for lymphatic mapping in laparoscopic and robotic gastrectomy for gastric cancer
Obscure duodenal malformation and other midgut malrotation defects in an elder with acute abdomen due to different prominent complicated pathology
No full textA 70-year old man with severe comorbidities, hemodynamically stable, was emergently admitted for bowel obstruction. His chronic intractable constipation had never been evaluated. The patient had no history of abdominal surgery. Computed tomography indicated a large obstructive rectosigmoid tumour and dolichocolon. Immediate rectoscopy confirmed the presence of the obstructive tumour. Additionally, on emergent laparotomy, a malformed right-sided duodenum with right-sided small bowel and other midgut malrotation defects, along with a small palpable lesion in the proximal descending colon, were also found. We performed a subtotal colectomy, mobilization of the only existing first and second duodenal portions, division of mesenteric root adhesions, and a terminal ileostomy. The patient had a favourable outcome, was discharged on day 8. Histology revealed a pT3N1b rectosigmoid adenocarcinoma and an 1 cm in diameter localized c-kit+ stromal tumour in the proximal descending colon. He received chemotherapy. The patient underwent a postoperative upper gastrointestinal contrast study which showed a well-functioning right-sided deranged duodenum. During a 36-months follow-up no recurrence of malignancy or of midgut malrotation defects has been recognized
Current Status of Indocyanine Green Tracer-Guided Lymph Node Dissection in Minimally Invasive Surgery for Gastric Cancer
Full text linkWith the rapid development and popularization of laparoscopic and robotic radical gastrectomy, gastric cancer surgery has gradually entered a new era of precise minimally invasive surgery. The era of precision medicine has put forth new requirements for minimally invasive surgical treatment of patients with gastric cancer at different disease stages. For patients with early gastric cancer, avoiding surgical trauma caused by excessive lymph node dissection improves quality of life while pursuing radical treatment of the tumor. In patients with advanced gastric cancer, systematic lymph node dissection can be achieved without increasing surgical complications. With the successful application of indocyanine green (ICG) fluorescence imaging technology in minimally invasive surgical instrumentation in recent years, researchers have found that ICG fluorescence imaging yields good tissue penetration and can identify lymph nodes in fat tissue better than other dyes. Therefore, whether ICG fluorescence imaging technology can guide surgeons in performing safe and effective lymph node dissection has attracted much attention. The present review discusses the clinical applications and research progress of ICG tracer-guided lymph node dissection in patients with gastric cancer
Evaluation of outcomes of 5cm all-around mesh reinforcement after endoscopic component separation and midline closure during laparoscopic ventral hernia repair
No full textBackground:
To evaluate the short term recurrence, pain scores, infection rates and cost factors by using 5cm all around composite mesh reinforcement of the closed defect after endoscopic video-assisted component separation for large ventral hernia repair.
Methods:
All patients who were clinically assessed to have large (≥5cm diameter of defect) midline ventral hernia underwent an abdominal CT as per protocol to calculate the Component Separation Index and were subjected to endoscopic video-assisted component separation. Next laparoscopy is done, hernial contents were reduced with adhesiolysis and midline defect is closed vertically with VLoc sutures, under physiologic tension. The closed suture line is reinforced with a mesh having a 5cm all round overlap irrespective of the original hernia defect.
Results:
A total of 30 patients were operated. Over a follow up period ranging from 3-18 months there were no recurrences, no surgical site infection, no seroma formation, no mesh infection, fewer tackers were required resulting in more favorable pain scores. Due to smaller mesh and fewer tackers there was significant cost reduction per case.
Conclusion:
Endoscopic component separation technique is useful in tension less large midline ventral hernia repair. Only 5cm all around mesh reinforcement of midline closure is required thus significantly cutting down the cost of surgery with excellent patient outcome
In the era of PPI, laparoscopic truncal vagotomy and gastrojejunostomy still plays an important role: A tertiary care centre experience in India
No full textBackground:
This study aims at sharing our experience with laparoscopic truncal vagotomy (TV) and gastrojejunostomy (GJ) and to highlight modifications in the form of posterior TV alone instead of anterior and posterior TV in elderly to reduce associated morbidity of prolonged gastric stasis.
Methods:
From 2017 to 2020, 16 patients underwent laparoscopic TV and GJ. Anterior and posterior TV was performed in patients younger than 60 years and posterior only TV was performed in patients older than 60 years. Antecolic, posterior, juxta-pyloric and isoperistaltic GJ was created using stapler. During follow up, patients were classified into Visick grading. Dumping syndrome was assessed using Dumping Syndrome Rating Scale (DSRS).
Results:
Mean age of patients was 58 years. Male:female ratio was 1.7:1. There were no conversions or perioperative mortality. Two patients required laparoscopic assisted GJ. Mean operative time was 117 minutes with mean blood loss of 23.89 ml. Thirteen patients were discharged by postoperative day seven; four had delayed gastric emptying which settled with conservative management and were discharged within second week. Incidence of prolonged gastric stasis was more in patients undergoing laparoscopic anterior and posterior TV and GJ as compared to those undergoing laparoscopic posterior TV and GJ (33.33% vs 20%, p>0.05). During average follow-up period of 22 months, one patient died due to unrelated cause. Patients were classified as Visick I (n=9), II (n=6), III (n=1), and IV (n=0) at the end of last follow-up. Two patients developed dumping syndrome which was managed by dietary modifications. None developed recurrent obstruction.
Conclusion:
Laparoscopic TV and GJ is feasible and safe for GOO secondary to PUD and is associated with satisfactory perioperative and post-operative outcomes. Posterior GJ using stapler is associated with reduced complication and operative time as well as hastened learning curve. Elderly patients tolerate posterior only TV better