1.Two-Layer Hand-Sewn Esophagojejunostomy in Totally Laparoscopic Total Gastrectomy for Gastric Cancer.
Enrique NORERO ; Rodrigo MUÑOZ ; Marco CERONI ; Manuel MANZOR ; Fernando CROVARI ; Mauricio GABRIELLI
Journal of Gastric Cancer 2017;17(3):267-276
PURPOSE: Different esophagojejunostomy (EJ) reconstruction methods are used after totally laparoscopic total gastrectomy (TLTG), and none is considered a standard technique. This report describes a 2-layer hand-sewn EJ technique during TLTG; we also evaluated postoperative morbidity associated with this technique. MATERIALS AND METHODS: This retrospective cohort study included all consecutive patients who underwent TLTG for gastric cancer (GC) from 2012 to 2016 at 2 affiliated teaching hospitals. All participating surgeons performed standardized intracorporeal 2-layer hand-sewn EJ. RESULTS: We included 51 patients who underwent TLTG for GC and standardized EJ anastomosis. Twenty-seven (53%) were male, and the median age was 60 (36–87) years. The average operative time was 337±71 minutes and intraoperative bleeding was 160±107 mL. There were no open conversions related to EJ. Postoperative morbidity was observed in 9 (17.0%) patients. There was no postoperative mortality. EJ leakage was observed in 2 patients (3.8%) and 1 patient (1.9%) developed EJ stenosis. Patients with leakage were managed non-operatively and the patient with stenosis required endoscopic dilation. The median length of hospital stay was 8 (6–29) days. CONCLUSIONS: Two-layer hand-sewn EJ during TLTG for GC is a feasible and safe technique. This method avoids a laparotomy for reconstruction and the disadvantages associated with laparoscopic introduction of mechanical staplers for EJ, and provides an alternative for alimentary tract reconstruction after TLTG.
Cohort Studies
;
Constriction, Pathologic
;
Gastrectomy*
;
Hemorrhage
;
Hospitals, Teaching
;
Humans
;
Laparoscopy
;
Laparotomy
;
Length of Stay
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Male
;
Methods
;
Mortality
;
Operative Time
;
Retrospective Studies
;
Stomach Neoplasms*
;
Surgeons
2.Impact of contrast dye submucosal pre-lifting on cold snare resection of small polyps: an Italian randomized observational trial
Ramona SCHIUMERINI ; Paola BACCARINI ; Adele FORNELLI ; Davide ALLEGRI ; Francesca LODATO ; Alessia GAZZOLA ; Pasquale APOLITO ; Nunzio P. LONGO ; Anna M. POLIFEMO ; Franca PATRIZI ; Federica BUONFIGLIOLI ; Stefania GHERSI ; Marco BASSI ; Liza CERONI ; Antonella GHETTI ; Giulio FONTI ; Vincenzo CENNAMO
Clinical Endoscopy 2025;58(2):291-302
Background/Aims:
Small polyps are the most frequently detected lesions during colonoscopy, with an incomplete resection rate of 6.8% to 15.9%. This study aimed to improve small polyp cold snare resection radicality using submucosal contrast dye pre-lifting (PL+CSP).
Methods:
This single-center, prospective, randomized controlled trial compared the standard cold snare polypectomy technique (PL-CSP) with PL+CSP to evaluate endoscopic and histological complete resection rates, adverse events, procedural times, and polyp retrieval failure rates.
Results:
In 143 patients consecutively enrolled, 186 small polyps were detected and randomly assigned following a 1:1 ratio to the PL-CSP (n=97, 51.6%) and PL+CSP (n=90, 48.4%) techniques. Endoscopic (p=0.97) and histologic (p=0.23) complete resection rates did not differ significantly even in univariate analysis. The intraprocedural bleeding rate was significantly higher in the PL+CSP group as confirmed by the univariate analysis (35.8% vs. 8.3%, p<0.001). The polyps retrieval failure rates were similar (p=0.83). Procedural time was significantly longer for PL+CSP (median time, 75 vs. 45 seconds; p<0.001), without impacting colonoscopy withdrawal time (p=0.215).
Conclusions
PL+CSP of small polyps did not improve endoscopic and histological complete resection rates and polyp sample retrieval. PL+CSP had higher rates of intraprocedural bleeding and was “time-consuming”.
3.Impact of contrast dye submucosal pre-lifting on cold snare resection of small polyps: an Italian randomized observational trial
Ramona SCHIUMERINI ; Paola BACCARINI ; Adele FORNELLI ; Davide ALLEGRI ; Francesca LODATO ; Alessia GAZZOLA ; Pasquale APOLITO ; Nunzio P. LONGO ; Anna M. POLIFEMO ; Franca PATRIZI ; Federica BUONFIGLIOLI ; Stefania GHERSI ; Marco BASSI ; Liza CERONI ; Antonella GHETTI ; Giulio FONTI ; Vincenzo CENNAMO
Clinical Endoscopy 2025;58(2):291-302
Background/Aims:
Small polyps are the most frequently detected lesions during colonoscopy, with an incomplete resection rate of 6.8% to 15.9%. This study aimed to improve small polyp cold snare resection radicality using submucosal contrast dye pre-lifting (PL+CSP).
Methods:
This single-center, prospective, randomized controlled trial compared the standard cold snare polypectomy technique (PL-CSP) with PL+CSP to evaluate endoscopic and histological complete resection rates, adverse events, procedural times, and polyp retrieval failure rates.
Results:
In 143 patients consecutively enrolled, 186 small polyps were detected and randomly assigned following a 1:1 ratio to the PL-CSP (n=97, 51.6%) and PL+CSP (n=90, 48.4%) techniques. Endoscopic (p=0.97) and histologic (p=0.23) complete resection rates did not differ significantly even in univariate analysis. The intraprocedural bleeding rate was significantly higher in the PL+CSP group as confirmed by the univariate analysis (35.8% vs. 8.3%, p<0.001). The polyps retrieval failure rates were similar (p=0.83). Procedural time was significantly longer for PL+CSP (median time, 75 vs. 45 seconds; p<0.001), without impacting colonoscopy withdrawal time (p=0.215).
Conclusions
PL+CSP of small polyps did not improve endoscopic and histological complete resection rates and polyp sample retrieval. PL+CSP had higher rates of intraprocedural bleeding and was “time-consuming”.
4.Impact of contrast dye submucosal pre-lifting on cold snare resection of small polyps: an Italian randomized observational trial
Ramona SCHIUMERINI ; Paola BACCARINI ; Adele FORNELLI ; Davide ALLEGRI ; Francesca LODATO ; Alessia GAZZOLA ; Pasquale APOLITO ; Nunzio P. LONGO ; Anna M. POLIFEMO ; Franca PATRIZI ; Federica BUONFIGLIOLI ; Stefania GHERSI ; Marco BASSI ; Liza CERONI ; Antonella GHETTI ; Giulio FONTI ; Vincenzo CENNAMO
Clinical Endoscopy 2025;58(2):291-302
Background/Aims:
Small polyps are the most frequently detected lesions during colonoscopy, with an incomplete resection rate of 6.8% to 15.9%. This study aimed to improve small polyp cold snare resection radicality using submucosal contrast dye pre-lifting (PL+CSP).
Methods:
This single-center, prospective, randomized controlled trial compared the standard cold snare polypectomy technique (PL-CSP) with PL+CSP to evaluate endoscopic and histological complete resection rates, adverse events, procedural times, and polyp retrieval failure rates.
Results:
In 143 patients consecutively enrolled, 186 small polyps were detected and randomly assigned following a 1:1 ratio to the PL-CSP (n=97, 51.6%) and PL+CSP (n=90, 48.4%) techniques. Endoscopic (p=0.97) and histologic (p=0.23) complete resection rates did not differ significantly even in univariate analysis. The intraprocedural bleeding rate was significantly higher in the PL+CSP group as confirmed by the univariate analysis (35.8% vs. 8.3%, p<0.001). The polyps retrieval failure rates were similar (p=0.83). Procedural time was significantly longer for PL+CSP (median time, 75 vs. 45 seconds; p<0.001), without impacting colonoscopy withdrawal time (p=0.215).
Conclusions
PL+CSP of small polyps did not improve endoscopic and histological complete resection rates and polyp sample retrieval. PL+CSP had higher rates of intraprocedural bleeding and was “time-consuming”.