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 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

OBJECTIVETo summarize the clinical experiences in percutaneous endoscopic gastrostomy (PEG)/percutaneous endoscopic jejunostomy (PEJ).

METHODSWe retrospectively analyzed the clinical data of 578 patients who received either PEG or PEJ from July 2001 to December 2007 in our hospital. The data analyzed included the type, aim, duration, success rate, and complications of these procedures.

RESULTSOf 578 patients, 247 patients underwent PEG, 293 patients underwent percutaneous endoscopic gastrojejunostomy (PEGJ), 4 patients received percutaneous endoscopic duodenostomy (PED), 4 patients underwent direct percutaneous endoscopic jejunostomy (DPEJ), 4 patients underwent percutaneous endoscopic colostomy (PEC), and 26 patients received PEG/J combined stents. These procedures were performed in different clinical conditions, including enteral nutrition (n = 329), decompression combined enteral nutrition (n = 133), decompression of the gastrointestinal tract (n = 103), enteral nutrition combined bile refeeding (n = 5), perioperative applications (n = 4), and coloclysis (n = 4). Tubes were successfully placed in 578 patients (98.0%) in an average time of (7.5 +/- 1.9) min in PEG, (17.7 +/- 4.2) min in PEGJ, (14.8 +/- 2.1) min in DPEJ, (12.3 +/- 2.5) min in PED, (11.3 +/- 2.6) min in PEC, and (30.2 +/- 5.2) min in PEG/J combined stent, respectively. No procedure-related complications were observed. Major complications were found in 6 patients (1.04%) and minor complications in 36 patients (6.23%). The duration of tube functioning was (168.37 +/- 198.64) d.

CONCLUSIONSPEG/PEJ are easy to handle, effective, safe, and convenient for nursing. The endoscopic method of tube placement can be performed at the bedside and allow for enteral feeding, gastrointestinal decompression, and internal biliary drainage to be rapidly and efficiently achieved.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Enteral Nutrition ; methods ; Female ; Gastroscopy ; adverse effects ; methods ; Gastrostomy ; adverse effects ; methods ; Humans ; Jejunostomy ; adverse effects ; methods ; Male ; Middle Aged ; Retrospective Studies ; Young Adult