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- Title
Enterotomy Closure after Minimally Invasive Distal Gastrectomy with Intracorporeal Anastomosis: A Multicentric Study.
- Authors
Milone, Marco; Vertaldi, Sara; Alfano, Marie Sophie; Agrusa, Antonino; Anania, Gabriele; Baiocchi, Gian Luca; Bianchi, Pietro Paolo; Biondi, Alberto; Bracale, Umberto; Buscemi, Salvatore; Chiozza, Matteo; Corcione, Francesco; D'Ugo, Domenico; Degiuli, Maurizio; De Simone, Giuseppe; Elmore, Ugo; Galli, Federica; Giuliani, Giuseppe; Maida, Pietro; Maione, Francesco
- Abstract
Introduction: Despite progressive improvements in technical skills and instruments that have facilitated surgeons performing intracorporeal gastro-jejunal and jejuno-jejunal anastomoses, one of the big challenging tasks is handsewn knot tying. We analysed the better way to fashion a handsewn intracorporeal enterotomy closure after a stapled anastomosis. Methods: All 579 consecutive patients from January 2009 to December 2019 who underwent minimally invasive partial gastrectomy for gastric cancer were retrospectively analysed. Different ways to fashion intracorporeal anastomoses were investigated: robotic versus laparoscopic approach; laparoscopic high definition versus three-dimensional versus 4K technology; single-layer versus double-layer enterotomies. Double-layer enterotomies were analysed layer by layer, comparing running versus interrupted suture; the presence versus absence of deep corner suture; and type of suture thread. Results: Significantly lower rates of bleeding (p = 0.011) and leakage (p = 0.048) from gastro-jejunal anastomosis were recorded in the double-layer group. Barbed suture thread was significantly associated with reduced intraluminal bleeding and leakage rates both in the first (p = 0.042 and p = 0.010) and second layer (p = 0.002 and p = 0.029). Conclusions: Double-layer sutures using barbed suture thread both in first and second layer to fashion enterotomy closure result in lower intraluminal bleeding and anastomotic leak rates.
- Subjects
GASTRECTOMY; STOMACH cancer; SUTURES; SUTURING
- Publication
Digestive Surgery, 2022, Vol 39, Issue 5/6, p232
- ISSN
0253-4886
- Publication type
Article
- DOI
10.1159/000526348