Background:Laparoscopic total gastrectomy (LTG) is increasingly performed in patients with gastric cancer. However, the usage of intracorporeal esophagojejunostomy (IEJ) following LTG is limited, as the safety and efficacy remain unclear. The present meta-analysis aimed to evaluate the feasibility and safety of IEJ following LTG.

Methods:Studies published from January 1994 to January 2017 comparing the outcomes of IEJ and extracorporeal esophagojejunostomy (EEJ) following LTG were reviewed and collected from the PubMed, EBSCO, Cochrane Library, Embase, and China National Knowledge Internet (CNKI). Operative results, postoperative recovery, and postoperative complications were compared and analyzed. The weighted mean difference (WMD) and odds ratio (OR) with a 95% confidence interval (CI) were calculated using the Review Manager 5.3.

Results:Seven nonrandomized studies with 785 patients were included. Compared with EEJ, IEJ has less blood loss (WMD: -13.52 ml; 95% CI: -24.82--2.22; P = 0.02), earlier time to first oral intake (WMD: -0.49 day; 95% CI: -0.83--0.14; P < 0.01), and shorter length of hospitalization (WMD: -0.62 day; 95% CI: -1.08--0.16; P < 0.01). There was no significant difference between IEJ and EEJ regarding the operation time, anastomotic time, number of retrieved lymph nodes, time to first flatus, anastomosis leakage rate, anastomosis stenosis rate, and proximal resections (all P > 0.05).

ConclusionsCompared with EEJ, IEJ has better cosmesis, milder surgical trauma, and a faster postoperative recovery. IEJ can be performed as safely as EEJ. IEJ should be encouraged to surgeons with sufficient expertise.

Esophagostomy ; adverse effects ; methods ; Esophagus ; surgery ; Gastrectomy ; adverse effects ; methods ; Humans ; Jejunostomy ; adverse effects ; methods ; Laparoscopy ; adverse effects ; methods ; Stomach Neoplasms ; surgery ; Treatment Outcome

Anti-Bacterial Agents ; administration & dosage ; therapeutic use ; Enteral Nutrition ; methods ; Food, Formulated ; Gastroesophageal Reflux ; drug therapy ; surgery ; therapy ; Gastroscopy ; Gastrostomy ; methods ; Humans ; Infant ; Jejunostomy ; Male ; Malnutrition ; drug therapy ; therapy ; Pneumonia, Aspiration ; drug therapy ; surgery ; therapy ; Teaching ; methods

OBJECTIVE: The purpose of our study was to assess the feasibility of performing percutaneous radiologic gastrostomy (PRG) in patients who had undergone partial gastrectomy and to evaluate factors associated with technical success. MATERIALS AND METHODS: Nineteen patients after partial gastrectomy, who were referred for PRG between April 2006 and April 2012, were retrospectively analyzed. The remnant stomach was punctured using a 21-gauge Chiba-needle. A single anchor was used for the gastropexy and a 12-Fr or 14-Fr gastrostomy tube was inserted. Data were collected regarding the technical success, procedure time, and presence of any complications. Univariable analyses were performed to determine the factors related to the technical success. RESULTS: Percutaneous radiologic gastrostomy was technically successful in 10 patients (53%), while a failed attempt and failure without an attempt were observed in 5 (26%) and 4 (21%) patients, respectively. Percutaneous radiologic jejunostomy was successfully performed in 9 patients who experienced technical failure. In the 10 successful PRG cases, the mean procedure time was 6.35 minutes. Major complications occurred in 2 patients, tube passage through the liver and pneumoperitonum in one and severe hemorrhage in the other. The technical success rate was higher in patients with Billroth I gastrectomy (100%, 6/6) than in patients with Billroth II gastrectomy (31%, 4/13) (p = 0.011). CONCLUSION: Percutaneous radiologic gastrostomy can be successfully performed using the one-anchor technique in approximately half of the patients after partial gastrectomy.
Aged ; Aged, 80 and over ; Analysis of Variance ; Feasibility Studies ; Female ; Gastrectomy/*methods ; Gastric Stump ; Gastrostomy/instrumentation/*methods ; Humans ; Jejunostomy/methods ; Male ; Middle Aged ; Operative Time ; Punctures/methods ; Radiography, Interventional ; Retrospective Studies ; Suture Anchors ; Treatment Outcome

OBJECTIVE: The aim of this study was to evaluate the frequency of postoperative biliary stricture and its risk factors in patients undergoing surgery for type I choledochal cyst. MATERIALS AND METHODS: A total of 35 patients with type I choledochal cyst underwent laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy between August 2004 and August 2011. Their medical records and radiologic images (including endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, pancreatobiliary computed tomography, or ultrasound) were retrospectively analyzed to evaluate the frequency of postoperative biliary stricture and its risk factors. RESULTS: Postoperative biliary stricture was found in 10 (28.6%) of 35 patients. It developed more frequently in patients with type Ia choledochal cyst (53.8%, 7 of 13 patients) than in patients with type Ic choledochal cyst (13.6%, 3 of 22 patients), which was statistically significant (p = 0.011). There were no significant associations between other factors and postoperative biliary stricture. CONCLUSION: Type Ia is a risk factor of postoperative anastomotic stricture. Therefore, preoperative radiologic subclassification of type Ia and Ic may be useful in predicting postoperative outcomes of choledochal cysts.
Adolescent ; Adult ; Anastomosis, Roux-en-Y ; Biliary Tract Surgical Procedures/methods ; Chi-Square Distribution ; Child ; Child, Preschool ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance ; Choledochal Cyst/*pathology/*surgery ; Female ; Humans ; Infant ; Jejunostomy/methods ; Laparoscopy/*methods ; Male ; Middle Aged ; Postoperative Complications/*diagnosis ; Statistics, Nonparametric ; Tomography, X-Ray Computed ; Treatment Outcome ; Ultrasonography/methods

OBJECTIVE: The aim of this study was to evaluate the frequency of postoperative biliary stricture and its risk factors in patients undergoing surgery for type I choledochal cyst. MATERIALS AND METHODS: A total of 35 patients with type I choledochal cyst underwent laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy between August 2004 and August 2011. Their medical records and radiologic images (including endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, pancreatobiliary computed tomography, or ultrasound) were retrospectively analyzed to evaluate the frequency of postoperative biliary stricture and its risk factors. RESULTS: Postoperative biliary stricture was found in 10 (28.6%) of 35 patients. It developed more frequently in patients with type Ia choledochal cyst (53.8%, 7 of 13 patients) than in patients with type Ic choledochal cyst (13.6%, 3 of 22 patients), which was statistically significant (p = 0.011). There were no significant associations between other factors and postoperative biliary stricture. CONCLUSION: Type Ia is a risk factor of postoperative anastomotic stricture. Therefore, preoperative radiologic subclassification of type Ia and Ic may be useful in predicting postoperative outcomes of choledochal cysts.
Adolescent ; Adult ; Anastomosis, Roux-en-Y ; Biliary Tract Surgical Procedures/methods ; Chi-Square Distribution ; Child ; Child, Preschool ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance ; Choledochal Cyst/*pathology/*surgery ; Female ; Humans ; Infant ; Jejunostomy/methods ; Laparoscopy/*methods ; Male ; Middle Aged ; Postoperative Complications/*diagnosis ; Statistics, Nonparametric ; Tomography, X-Ray Computed ; Treatment Outcome ; Ultrasonography/methods

The present paper is aimed to evaluate safety and efficiency of a biodegradable biliary stent used in the Roux-en-Y cholangiojejunostomy of dogs in vivo. We separated 18 hybrid dogs into control group and experimental group randomly, with each group 9 dogs. The Roux-en-Y cholangiojejunostomy was carried out in the two groups. We placed the biodegradable stents into the anastomotic stoma of the dogs in the experimental group during the operation. After 3 months' close observation, we evaluated the degradable property and biocompatibility of the stents. We found that the morbidity rate of bile leakage in the dogs in the control group was much higher than that in the experimental group (P > 0.05). The X-ray photograph showed that the figures of the stents were complete and the stents were fixed at right place throughout the experimental period. The diameter of the dogs' common bile ducts of control group narrowed down obviously compared to those in the experimental group (P < 0.05). There were no impure materials adhered to the inside walls of the stents. The pathological test showed that there were no inflammation signs in mucous membrane and abnormal epithelium hyperplasia of the bile tract and jejunum. It can be concluded that the biliary duct stent, which was made with a mixture of poly-L-lactic acid (PLLA) and poly lactide-co-glycolide (PLGA), possesses qualities of relatively long degradable period (> 3 months) and good biocompatibility. Moreover, using the stent can effectively prevent bile leakage and anastomotic stom stenosis in the cholangio-intestinal anastomosis from happening.
Absorbable Implants ; Anastomosis, Roux-en-Y ; Animals ; Cholestasis ; pathology ; surgery ; Common Bile Duct ; surgery ; Dogs ; Female ; Jejunostomy ; methods ; Lactic Acid ; chemistry ; Male ; Polyesters ; Polyglycolic Acid ; chemistry ; Polymers ; chemistry ; Random Allocation ; Stents

OBJECTIVETo explore and evaluate the therapeutic efficacy of surgical treatment for cancer of the pancreatic head.

METHODSThe clinical data of 96 patients with cancer of the pancreatic head admitted in our hospital from January 2002 to December 2009 were retrospectively analyzed. pancreatoduodenectomy was performed in 48 cases, extended pancreatoduodenectomy in 30 cases, and Roux-Y cholangiojejunostomy in 18 cases.

RESULTSThe 1, 2 and 3-year survival rates were 59.2%, 41.8% and 13.2%, respectively, in the patients treated with pancreatoduodenectomy, and 73.2%, 58.2% and 24.1%, respectively, in the patients treated with extended pancreatoduodenectomy. The 1, 2 and 3-year survival rates were 36.8%, 15.8% and 5.3%, respectively, in the patients with unresectable tumor who received radiotherapy and (or) chemotherapy in Roux-Y cholangiojejunostomy. The postoperative morbidity was 29.2%, 30.0% and 27.8% in the patients treated with pancreatoduodenectomy, extended pancreatoduodenectomy and Roux-Y cholangiojejunostomy, respectively.

CONCLUSIONSPancreatoduodenectomy is the most effective treatment. Extended pancreatoduodenectomy can improve the surgical resection rate, reduce the recurrence rate and improve the survival rate. Internal drainage is an important palliative measure.

Adult ; Aged ; Anastomosis, Roux-en-Y ; methods ; Female ; Follow-Up Studies ; Humans ; Jejunostomy ; methods ; Male ; Middle Aged ; Pancreatic Neoplasms ; mortality ; surgery ; Pancreaticoduodenectomy ; methods ; Postoperative Complications ; Retrospective Studies ; Survival Rate

BACKGROUNDMost gastric cancer patients who undergo gastrectomy develop malnutrition. It is, therefore, crucial to establish an effective means to provide nutrition for these patients. To perform home enteral nutrition (EN) to ensure adequate nutritional intake in gastric cancer patients, we placed a jejunostomy catheter during gastric surgery. Most patients showed improved nutritional status.

METHODSTwenty-nine inpatients at our hospital underwent radical gastrectomy and jejunostomy from December 2002 to December 2007 and were designated as the jejunostomy group, and 32 matched patients without a jejunostomy tube were designated as the tube-free group. The jejunostomy group was treated with EN from 72 hours to 3 months postoperatively. The tube-free group did not receive EN. Data including preoperative and postoperative body weight, body mass index (BMI), nutrition risk screening (NRS) score, Karnofsky performance score (KPS), and laboratory biochemical indicators were documented respectively and compared.

RESULTSCompared with preoperative week 1, both groups showed decreased body weight and BMI at 3 months postoperatively. The weight loss in the jejunostomy group ((7.1 ± 3.3) kg) was significantly less than that in the tube-free group ((9.9 ± 3.1) kg). Similarly, BMI decreased by (2.4 ± 1.0) kg/m(2) in the jejunostomy group, which was significantly less than in the tube-free group ((3.2 ± 0.9) kg/m(2)). The number of patients with postoperative NRS ≥ 3 was decreased in the jejunostomy group, but was increased in the tube-free group, and this difference was significant. There were no significant differences between the two groups in total lymphocyte count, hemoglobin, albumin and prealbumin, and adverse drug effects.

CONCLUSIONSShort-term (3 months) EN supplementation via jejunostomy tube can reduce the risk of malnutrition and weight loss, and improve tolerance of chemotherapy. Tube feeding is reliable for achieving these goals because it is not important whether or not the patients have appetites.

Aged ; Body Weight ; Enteral Nutrition ; methods ; Female ; Gastrectomy ; methods ; Humans ; Intubation, Gastrointestinal ; methods ; Jejunostomy ; methods ; Male ; Postoperative Period ; Stomach Neoplasms ; surgery

OBJECTIVETo evaluate influences on intestinal structure and myoelectric motility between modified uncut jejunal loop and Roux-en-Y procedures for biliodigestive anastomosis.

METHODSFifteen rabbits were randomized in modified uncut jejunal loop group, Roux-en-Y group and control group. Traced fasting slow-wave frequency (SWF) before biliodigestive diversion and 25 d postoperative (POD25) during laparotomy. Before the second laparotomy on POD21, the fasting SWF, percentage of abroad migrating myoelectric complex (MMC%), the postprandial spike potential frequency (SPF) and percentage of abroad propagation (SP%) were recorded in vivo. Compared myoelectric recordings according to parameters above. On POD90, harvested the stitched ligation of ascending loop and part of descending loop in uncut group, and biliary limb in R-Y animals, which assessed under HE, c-kit labeling immunohistochemical staining and transmission electron microscope(TEM).

RESULTSOn POD25, SWF declined mildly in uncut group (8.4%) and markedly in R-Y group (23.8%) respectively. The difference was significant (P<0.05). Before laparotomy on POD21 when abdomen closed, between uncut and control animals, there were statistical difference in fasting SWF and postprandial SPF (P<0.05), while no significance in MMC% and SP% (P>0.05). Moreover, differences of each parameters between R-Y group and control or uncut group were markedly statistical (P<0.01). Abroad myoelectric propagation through the ligated segment can be observed in uncut animals. Meanwhile, ectopic pacemaker was detected locating in the proximal segment of the Roux limb and triggering retrograde propagation in R-Y animals. On POD90, no recanalization were observed In uncut animals. Furthermore, occluded lumen with mild atrophic mucosa under microscope and c-kit labeling cells located in the inner circular muscle layer were observed, which proven to be Interstitial cells of Cajal (ICCs) by TEM. In R-Y animals, lumen of the Roux limb dilated. There's no significant difference in c-kit labeling area between R-Y and uncut animals by image analysis system. Reductions of processes and intercellular gap junction in ICCs, and loose interconnections between ICCs and SMCS or nerve endings were observed in R-Y animals.

CONCLUSIONSImpaired gastrointestinal motility after the Roux-en-Y procedure may due to the aberrant interstitial cells of Cajal. Modified uncut technique reveals a reliable and effective alternative for biliodigestive reconstruction.

Anastomosis, Roux-en-Y ; Animals ; Electrophysiology ; Female ; Intestines ; metabolism ; physiology ; surgery ; ultrastructure ; Jejunostomy ; methods ; Peristalsis ; physiology ; Postoperative Period ; Proto-Oncogene Proteins c-kit ; metabolism ; Rabbits ; Random Allocation

OBJECTIVETo explore the clinical value of percutaneous endoscopic gastrostomy/jejunostomy (PEG/J) in critically ill patients.

METHODSWe retrospectively analysed the clinical data of 30 critically ill patients who received PEG/J in our hospital. The indications, key operation procedures, peri-operative preparation, complications, and efficacy were recorded.

RESULTSTwenty-nine critically ill patients successfully received PEG/J. The mean operation time of PEG and PEJ were (7.5 +/- 2.5) min and (12.5 +/- 8.2) min, respectively, and the duration of tube functioning was (230 +/- 159) d; no procedure-related complications and serious complications were observed. Complications included local soft tissue infection (n = 1), J-tube dislodgment (n = 1), and obstruction of jejunal tube (n = 2). The serum levels of albumin and pre-albumin increased 4 weeks after operation; however, no significant difference was observed.

CONCLUSIONPEG/J is an effective, micro-invasive, safe, and convenient approach to establish a long-term gastrointestinal nutrition route for critically ill patients.

Aged ; Aged, 80 and over ; Critical Illness ; Enteral Nutrition ; methods ; Female ; Gastroscopy ; adverse effects ; methods ; Gastrostomy ; adverse effects ; methods ; Humans ; Jejunostomy ; adverse effects ; methods ; Male ; Middle Aged ; Retrospective Studies ; Serum Albumin ; metabolism