Prevention of Internal Hernia During Robotic Total Gastrectomy for Gastric Cancer.
Prevention of Internal Hernia During Robotic Total Gastrectomy for Gastric Cancer.
复制标题
机器人全胃切除术治疗胃癌期间内疝的预防。
DOI：
10.1007/s11605-018-3678-0
复制
发表时间：
2018
影响因子：
3.2
通讯作者：
Yamaue H.
中科院分区：
文献类型：
--
作者：
Ojima T;Nakamura M;Nakamori M;Hayata K;Katsuda M;Tsuji T;Maruoka S;Yamaue H.
手术后腹内疝是一种通过医源性肠系膜缺损的内脏急性突出，可能危及生命。在我们对1943例接受手术的连续胃癌（GC）患者进行的回顾性研究中，腹腔镜全胃切除术（LTG）后IH的发生率为4.9%。1这种高发生率似乎是由LTG后粘连形成减少引起的。关于机器人全胃切除术（RTG）期间的孔口管理尚未达成共识。因此，我们开发了一种新的程序，在RTG.MethodsWe结肠前Roux-en-Y重建使用da芬奇S系统（直观，桑尼维尔，CA）进行RTG的IH预防。我们选择了小肠内食管空肠侧侧吻合术（重叠法）。2首先，回收胃后，在直视下闭合空肠空肠吻合术的肠系膜缺损。其次，在腹腔镜下使用机器人缝合关闭食管裂孔和Petersen缺损。3最后，固定十二指肠残端和Roux肢体以防止Roux肢体扭转。ResultsWe在2017年5月至10月期间对5名患者进行了此手术。中位手术持续时间为395分钟（范围：319-442分钟），中位出血量为60 ml（范围：35-140 ml）。有没有高于Clavien-Dindo II级在任何patients.4随访期的并发症，虽然不到1年，没有IH后RTG已被观察到在任何patients.ConclusionRegarding短期手术结果，该程序是推荐用于GC患者接受RTG。然而，需要对接受RTG并闭合所有肠系膜缺损的患者进行更长期的随访。
BackgroundPostoperative internal hernia (IH) is a potentially life-threatening acute protrusion of viscus through an iatrogenic mesenteric defect. In our retrospective study of 1943 consecutive gastric cancer (GC) patients who had undergone surgery, the incidence of IH after laparoscopic total gastrectomy (LTG) was 4.9%.1 This high incidence seems to be caused by decreased adhesion formation after LTG. There is no consensus regarding orifice management during robotic total gastrectomy (RTG). We therefore developed a new procedure for IH prevention during RTG.MethodsWe performed RTG with antecolic Roux-en-Y reconstruction using the da Vinci S system (Intuitive, Sunnyvale, CA). We chose an intracorporeal side-to-side esophagojejunostomy (overlap method).2 First, mesenteric defect of jejunojejunostomy was closed under direct vision following retrieval of the stomach. Second, the esophagus hiatus and Petersen’s defect were closed under laparoscopic vision using robotic suture.3 Finally, the duodenal stump and the Roux limb were fixed to prevent torsion of the Roux limb.ResultsWe performed this procedure on five patients between May and October 2017. The median duration of surgery was 395 min (range, 319–442 min), median bleeding was 60 ml (range, 35–140 ml). There were no anastomosis-related complications higher than Clavien-Dindo grade II in any patients.4 Although the follow-up period is less than 1 year, no IH after RTG has been observed in any patients.ConclusionRegarding short-term surgical outcomes, this procedure is recommended for GC patients who undergo RTG. However, more long-term follow-up for patients who have undergone RTG with closure of all mesenteric defects is required.