Endoscopy plays an important role in the diagnosis and treatment of postoperative complications of gastric cancer. Endoscopic intervention can avoid the second operation and has attracted wide attention. Early gastric anastomotic bleeding after gastrectomy is the most common. With the development of technology, emergency endoscopy and endoscopic hemostasis provide a new treatment approach. According to the specific circumstances, endoscopists can choose metal clamp to stop bleeding, electrocoagulation hemostasis, local injection of epinephrine or sclerotherapy agents, and spraying specific hemostatic agents. Anastomotic fistula is a serious postoperative complication. In addition to endoscopically placing the small intestine nutrition tube for early enteral nutrition support treatment, endoscopic treatment, including stent, metal clip, OTSC, and Over-stitch suture system, can be chosen to close fistula. For anastomotic obstruction or stricture, endoscopic balloon or probe expansion and stent placement can be chosen. For esophageal anastomotic intractable obstruction after gastroesophageal surgery, radial incision of obstruction by the hook knife or IT knife, a new method named ERI, is a good choice. Bile leakage caused by bile duct injury can be treated by placing the stent or nasal bile duct. In addition, endoscopic methods are widely used as follows: abdominal abscess can be treated by the direct intervention under endoscopy; adhesive ileus can be treated by placing the catheter under the guidance of endoscopy to attract pressure; alkaline reflux gastritis can be rapidly diagnosed by endoscopy; gastric outlet obstruction mainly caused by cancer recurrence can be relieved by metal stent placement and the combination of endoscopy and X-ray can increase success rate; pyloric dysfunction and spasm caused by the vagus nerve injury during proximal gastrectomy can be treated by endoscopic pyloromyotomy, a new method named G-POEM, and the short-term outcomes are significant. Endoscopic submucosal dissection (ESD) allows complete resection of residual gastric precancerous lesions, however it should be performed by the experienced endoscopists.
Anastomosis, Surgical ; adverse effects ; Bile Ducts ; injuries ; Constriction, Pathologic ; etiology ; therapy ; Digestive System Fistula ; etiology ; therapy ; Duodenogastric Reflux ; diagnostic imaging ; etiology ; Endoscopy, Gastrointestinal ; methods ; Enteral Nutrition ; instrumentation ; methods ; Female ; Gastrectomy ; adverse effects ; Gastric Outlet Obstruction ; surgery ; Gastritis ; diagnosis ; Gastrointestinal Hemorrhage ; etiology ; therapy ; Hemostasis, Endoscopic ; methods ; Hemostatics ; administration & dosage ; therapeutic use ; Humans ; Male ; Neoplasm Recurrence, Local ; surgery ; Postoperative Complications ; diagnosis ; therapy ; Precancerous Conditions ; surgery ; Pylorus ; innervation ; physiopathology ; surgery ; Stents ; Stomach Neoplasms ; complications ; surgery ; Treatment Outcome ; Vagus Nerve Injuries ; etiology ; surgery

A new anastomat for digestive tract operations, based on the magnetic compressive technique and mechanical transmission mechanism, is composed of a removable head and a reusable body. The head includes two parts: the proximal end can be fixed to the body, and the distal end could be used for performing a purse string suture. The procedure of anastomosis is similar to that of the stapler, and the anastomoses is established using a pair of magnetic rings. The instrument makes magnamosis more simple and feasible, and it would facilitate the clinical application. The body of the anastomat is reusable and the head could be replaced according to the clinical scenarios, these could reduce the medical cost. The magnetic rings would be excreted with the feces, and there is no foreign body response at last.
Anastomosis, Surgical ; instrumentation ; methods ; Gastrointestinal Tract ; surgery ; Humans ; Magnetics

OBJECTIVETo compare the associated anastomotic complication of cervical esophagogastric anastomosis between stapled and hand-sewn anastomosis in minimally invasive esophagectomy(MIE).

METHODSClinical data of 203 patients with esophageal cancer receiving combined thoracoscopic and laparoscopic esophagectomy with anastomosis in the neck in our hospital from January 2010 to November 2013 were retrospectively analyzed. All the patients were divided into stapled group(104 patients) and hand-sewn group(99 patients). The incidence of anastomotic leakage and anastomotic stricture between these two groups were compared.

RESULTSThere were no significant differences between two groups in gender, age, body mass index, total protein, albumin, and neoadjuvant chemotherapy(all P>0.05). There was no significant difference between the two groups in the incidence of anastomotic leakage [6/104(5.77%) vs. 3/99(3.03%), P>0.05], while the difference in the incidence of anastomotic stricture was significant [10/104(9.62%) vs. 2/99(2.02%), P<0.05]. The time of anastomosis, dieting and hospital stay was (15.5±5.0) min, (5.0±2.8) d and (18.3±5.9) d in stapled group, which was significantly shorter than (28.0±4.5) min, (5.9±1.2) d and (21.8±4.2) d in hand-sewn group(all P<0.05).

CONCLUSIONIn the minimally invasive esophagectomy, stapled cervical esophagogastric anastomosis is simple and precise, but it is associated with increased risk of anastomotic stricture, therefore the type of anastomosis should be chosen based on the conditions of the patient.

Anastomosis, Surgical ; Anastomotic Leak ; etiology ; Constriction, Pathologic ; etiology ; Esophageal Neoplasms ; surgery ; Esophagectomy ; instrumentation ; methods ; Humans ; Laparoscopy ; Minimally Invasive Surgical Procedures ; instrumentation ; methods ; Retrospective Studies ; Sutures ; Treatment Outcome

OBJECTIVETo explore the value of employing the small intestinal feeding tube in treating high position intestinal obstruction of newborn infant.

METHODFive newborn infants (3 males and 2 females; 1 premature infant and 4 fully-mature infants; 2 had membranous atresia of duodenum, 1 had annular pancreas, and 2 had proximal small intestine atresia; 1 infant had malrotation). The duodenal membrane-like atresia and the blind-end of small intestine were removed and intestinal anastomosis was performed, which was combined with intestinal malrotation removal. Before the intestinal anastomosis surgery, the anesthetist inserted via nose a 6Fr small intestinal ED tube, made by CREATE MEDIC CO LTD of Japan[

REGISTRATION NUMBERthe State Food and Drug Administration-instrument (Im.) 2007-NO.2661620]. Twenty-four hours after surgery, abdominal X-ray plain film was taken and patients were fed with syrup; 48 hours later, formula milk was pumped or lactose-free milk amino acids were given by intravenous injection pump through the feeding tube. The amount of milk and fluids was gradually increased to normal amount according to the condition. In initial 3 days the intravenous nutrition was given and one week after operation, the infants were fed through mouth in addition to pumping milk through the tube and stopped infusion. Ten to 22 days after operation, the tube was removed and the infant patients were discharged.

RESULTAll the five infants showed that the feeding through the nutrition tube was accomplished and the time of venous nutrition was reduced and fistula operation was avoided. None of the infants on question was off the tube and no jaundice exacerbation was found and the liver function was also found normal. At the very beginning, the tube was occasionally blocked by milk vale in one infant and after 0.9% sodium chloride solution flushing patency restored. After that, the feeding tube was washed once with warm water after feeding. In one infant vomiting occurred due to enough oral milk. The photograph of upper gastrointestine did not show anastomomotic stricture or fistula, or intestinal obstruction. After pulling out the tube, the symptoms disappeared and then the patient was discharged. One child was found to have diarrhea with no lactose nutrition liquid and given compound lactic bacteria preparations for oral administration, the symptom disappeared. In the 5 cases, the shortest hospital stay was 10 days and the longest was 22 days, the average stay was 16 days. Three to 5 days after operation the weight restored to birth weight, the weight had increased, when discharged, to an average of 5.5 g (kg·d).

CONCLUSIONThe small intestinal feeding tube was very effective for the postoperative nutrition maintenance of high position intestinal obstruction in newborn infants.

Anastomosis, Surgical ; Enteral Nutrition ; instrumentation ; methods ; Female ; Humans ; Infant, Newborn ; Intestinal Atresia ; surgery ; Intestinal Obstruction ; surgery ; Intestine, Small ; abnormalities ; surgery ; Intubation, Gastrointestinal ; instrumentation ; methods ; Length of Stay ; Male ; Nose ; Postoperative Care ; methods ; Retrospective Studies ; Time Factors ; Weight Gain

OBJECTIVE: To retrospectively evaluate the feasibility and effectiveness of three-tube insertion for the treatment of postoperative gastroesophageal anastomotic leakage (GEAL). MATERIALS AND METHODS: From January 2007 to January 2011, 28 cases of postoperative GEAL after an esophagectomy with intrathoracic esophagogastric anastomotic procedures for esophageal and cardiac carcinoma were treated by the insertion of three tubes under fluoroscopic guidance. The three tubes consisted of a drainage tube through the leak, a nasogastric decompression tube, and a nasojejunum feeding tube. The study population consisted of 28 patients (18 males, 10 females) ranging in their ages from 36 to 72 years (mean: 59 years). We evaluated the feasibility of three-tube insertion to facilitate leakage site closure, and the patients' nutritional benefit by checking their serum albumin levels between pre- and post-enteral feeding via the feeding tube. RESULTS: The three tubes were successfully placed under fluoroscopic guidance in all twenty-eight patients (100%). The procedure times for the three tube insertion ranged from 30 to 70 minutes (mean time: 45 minutes). In 27 of 28 patients (96%), leakage site closure after three-tube insertion was achieved, while it was not attained in one patient who received stent implantation as a substitute. All patients showed good tolerance of the three-tube insertion in the nasal cavity. The mean time needed for leakage treatment was 21 +/- 3.5 days. The serum albumin level change was significant, increasing from pre-enteral feeding (2.5 +/- 0.40 g/dL) to post-enteral feeding (3.7 +/- 0.51 g/dL) via the feeding tube (p < 0.001). The duration of follow-up ranged from 7 to 60 months (mean: 28 months). CONCLUSION: Based on the results of this study, the insertion of three tubes under fluoroscopic guidance is safe, and also provides effective relief from postesophagectomy GEAL. Moreover, our findings suggest that three-tube insertion may be used as the primary procedure to treat postoperative GEAL.
Adult ; Aged ; Anastomosis, Surgical ; Anastomotic Leak/radiography/*therapy ; Decompression, Surgical/instrumentation ; Drainage/instrumentation ; Enteral Nutrition/instrumentation ; Esophageal Neoplasms/*surgery ; Esophagectomy ; Female ; Fluoroscopy ; Humans ; Intubation, Gastrointestinal/*methods ; Male ; Middle Aged ; Postoperative Complications/*radiography/*therapy ; Radiography, Interventional/*methods ; Retrospective Studies ; Stomach Neoplasms/*surgery

OBJECTIVETo evaluate the benefit of placement of dual double-J stents following high-pressure balloon angioplasty for treatment of ureter-ileum anastomosis stricture after total bladder resection.

METHODSSeventeen patients (11 males and 6 females, mean age 56.65±6.28 years, 23 sides) undergoing total bladder resection were included in this study. Unilateral and bilateral ureteral stricture occurred postoperatively in 11 and 6 patients, respectively; 13 patients had ureter-ileum bladder anastomosis stricture after ileal bladder substitution, and 4 patients had ureter-ileum stricture after orthotopic construction of ileal neobladder. The control group consisted of 21 patients undergoing open surgery.

RESULTSIn the double-J stenting group, the effective rate was 82.6% (19/23), similar to that of 85.7% (18/21) in the control group (P>0.05). Compared with the control group, the stenting group showed a significantly reduced mean time of operation (87.42±10.35 min vs 34.12±7.52 min, P<0.05), intraoperative blood loss (203.16±32.67 ml vs 21.54±6.15 ml, P<0.05), and mean postoperative hospital stay (10.12±1.19 vs 3.24±0.35 days, P<0.05).

CONCLUSIONAs a safe and minimally invasive approach to the management of ureter-ileum bladder anastomosis stricture, placement of dual double-J stents following high-pressure balloon angioplasty produces a effect comparable with that of open surgery.

Aged ; Anastomosis, Surgical ; adverse effects ; methods ; Angioplasty, Balloon ; methods ; Constriction, Pathologic ; etiology ; therapy ; Cystectomy ; Female ; Humans ; Ileum ; surgery ; Male ; Middle Aged ; Stents ; Ureter ; surgery ; Urinary Bladder ; surgery ; Urinary Diversion ; adverse effects ; instrumentation ; methods

OBJECTIVETo summarize the experience in the application of circumcision anastomat in the treatment of phimosis and redundant prepuce in children.

METHODSA total of 551 children with phimosis or redundant prepuce were treated by circumcision from 2008 to 2010, 342 with circumcision anastomat and the other 209 by traditional circumcision. Their clinical data were retrospectively analyzed.

RESULTSCompared with traditional circumcision, circumcision with the anastomat showed the advantages of less operation time (P < 0.05), fewer complications, no need for dressing, and better cosmetic appearance, but it also exhibited the disadvantages of longer healing time (P < 0.05) and more obvious postoperative pain (P < 0.05).

CONCLUSIONCircumcision with the anastomat and traditional circumcision for the treatment of phimosis and redundant prepuce in children each have their own advantages and disadvantages, but the former is more advantageous and more feasible clinically.

Adolescent ; Anastomosis, Surgical ; Child ; Circumcision, Male ; instrumentation ; methods ; Humans ; Male ; Phimosis ; surgery ; Treatment Outcome

OBJECTIVETo evaluate safety and feasibility of circular staplers in cervical esophagogastrostomy after esophageal cancer resection.

METHODSThe clinical data of patients with esophageal carcinoma were analyzed retrospectively. These patients underwent esophagectomy and cervical esophagogastrostomy with mechanical staplers from August 2009 to April 2011 in the Henan Provincial People's Hospital.

RESULTSA total of 202 patients had the anastomosis performed successfully except for one case who had esophageal tear during anastomosis and required hand-sewn repair. There was no operative mortality. Six patients developed cervical anastomotic leakage after operation, and all were treated conservatively. There was no thoracic anastomotic leakage and other complications related to anastomosis. Two patients had obvious gastroesophageal reflux. After a median of 10.2 months of follow-up, there was no anastomotic stricture.

CONCLUSIONCircular mechanical stapling in cervical esophagogastric anastomosis is a safe and feasible operative procedure.

Adult ; Aged ; Aged, 80 and over ; Anastomosis, Surgical ; instrumentation ; methods ; Esophageal Neoplasms ; surgery ; Esophagectomy ; methods ; Esophagus ; surgery ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Stomach ; surgery ; Sutures

OBJECTIVE: To assess the safety and efficacy of gastrointestinal anastomosis with nickel titanium shape memory alloy compression anastomosis clip. METHODS: We randomized 51 patients to undergo gastrointestinal anastomosis with stapler (n=25) and nickel titanium compression anastomosis clip (n=26) respectively. The following parameters were recorded to evaluate the safety and efficacy: mean hospitalization time, anastomotic complication, first post-operation flatus and bowel movement, and extrusion of the clip. RESULTS: Anastomotic complications such as leakage, stenosis and obstruction were not observed in both groups. There were no significant differences in the first post-operation flatus time and bowel movement time between the 2 groups (P>0.05). The clip was expelled with stool within 9-15 d. CONCLUSION Compression anastomosis clip is safe and effective.
Anastomosis, Surgical ; instrumentation ; methods ; Anastomotic Leak ; prevention & control ; Digestive System Surgical Procedures ; methods ; Female ; Gastroenterostomy ; instrumentation ; methods ; Gastrointestinal Diseases ; pathology ; surgery ; Humans ; Male ; Nickel ; Surgical Staplers ; Titanium

OBJECTIVETo evaluate the safety and efficacy of a novel nickel-titanium memory alloy compression anastomosis ring(CAR27) for colorectal anastomosis.

METHODSOne sigmoid cancer patient undergone lower anterior resection(LAR) received colorectal anastomosis with CAR27 on November 12, 2009. The following parameters were recorded during 4 weeks postoperative follow-up:colorectal anastomotic complication,first post-operation flatus and bowel movement, extrusion of ring device.

RESULTSThe total operation time was 42 minutes, including 11 minutes for colorectal anastomosis. The patient had flatus at the first day and began feeding at the second day postoperatively. The ring was expelled with stool at the 10th day postoperatively. Patient didn't have anastomotic complications such as leakage or obstruction during 1 month postoperative follow-up.

CONCLUSIONThis case study primarily indicates CAR27 is safe and feasible for colorectal anastomosis.

Anastomosis, Surgical ; instrumentation ; methods ; Colorectal Neoplasms ; surgery ; Female ; Humans ; Middle Aged ; Nickel ; Rectum ; surgery ; Titanium