Gastric Resection Research Articles

Successful treatment of nonocclusive mesenteric ischemia in a reconstructed jejunum after esophagectomy and remnant gastric tube resection: a case report

BackgroundNonocclusive mesenteric ischemia (NOMI), an ischemic bowel disease without a disruption of the mesenteric blood flow or strangulation of the mesentery or intestine, may cause a lethal clinical course. We report a very rare case of jejunal necrosis caused by NOMI in the pedicled mesentery of the reconstructed jejunum after remnant gastric tube resection for heterochronous gastric tube cancer after esophagectomy.Case presentationAn 80-year-old man visited our department with chief complaints of fever and appetite loss after 4 months from gastric tube resection and digestive reconstruction with pedicled jejunum. Contrast-enhanced computed tomography (CT) revealed impaired blood flow without torsion of the mesentery, severe wall thickness, and micro-penetration in the reconstructed jejunum and combined pyothorax in the right thoracic cavity. Esophagogastroduodenoscopy demonstrated extensive mucosal necrosis confined to the jejunum, which was elevated in the thoracic cavity. The jejunal necrosis due to NOMI occurring in the reconstructed jejunum was suspected, and lifesaving small bowel resection with right thoracotomy was considered necessary. However, radical operation with right thoracotomy was considered to be excessively invasive and not valid due to the patient’s poor physical status, advanced age, and presence of left adrenal metastasis from the remnant gastric cancer. Therefore, we selected the conservative treatment with fasting, transnasal drainage, and administration of antibiotics due to the patient’s intention. CT-guided right thoracic drainage for the intrathoracic abscess was needed 10 days after starting treatment and the inflammatory response rapidly improved. Follow-up CT and esophagogastroduodenoscopy revealed the improvement in the ischemic changes in jejunal mucosa without perforation. Intake was initiated at 20 days after symptom onset, and the patient was discharged at 40 hospital days without any complications and sequelae.ConclusionsTo the best of our knowledge, this is the first case of NOMI occurring in the reconstructed jejunum after remnant gastric tube resection that was successfully treated with a conservative treatment. For NOMI, it is important to make appropriate diagnosis based on imaging findings and perform proper assessment of the patient’s condition. Conservative treatments may be also useful depending on the patient’s condition.

A meta-analysis of the effect of laparoscopic gastric resection on the surgical site wound infection in patients with advanced gastric cancer.

By conducting a meta-analysis of relevant clinical studies on the treatment of advanced gastric cancer (GC) using laparoscopic and open surgeries, we aimed to evaluate the impact of these two surgical approaches on postoperative surgical site infections (SSIs) in patients with advanced GC. We aimed to provide evidence-based support for preventing SSIs in postoperative patients with advanced GC. From database establishment until May 2023, we systematically searched PubMed, Cochrane Library, MEDLINE, Embase, China National Knowledge Infrastructure, and Wanfang Data databases for relevant studies comparing laparoscopic and open surgeries for the treatment of advanced GC. Two researchers independently performed the literature screening and data extraction based on predefined inclusion and exclusion criteria. The meta-analysis was conducted using STATA 17.0. Twenty articles involving 3084 patients met the inclusion criteria, including 1462 patients in the laparoscopic group and 1622 cases in the open surgery group. The meta-analysis results revealed that the incidence of postoperative SSIs was significantly lower in the laparoscopic group than in the open surgery group (odds ratio = 0.341, 95% confidence interval: 0.219-0.532, p < 0.001). The current evidence indicates that laparoscopic radical gastrectomy can significantly reduce the incidence of postoperative site infections in patients with advanced GC.

The influence of short-term postoperative outcomes on overall survival after gastric cancer surgery.

Gastrectomy with lymphadenectomy in combination with perioperative chemotherapy is the cornerstone of modern curative treatment for gastric adenocarcinoma. The primary objective of this study was to assess the influence of textbook outcome, postoperative complications, and readmission on survival in patients who underwent gastric cancer surgery. Consecutive patients who underwent curative and prophylactic gastric resections from 2014 to 2022 at Christchurch Hospital were identified from the hospital database. Multivariable analyses were performed to assess risk factors for each postoperative outcome. A survival analysis was performed to evaluate the influence of these outcomes on overall survival. Seventy-seven patients underwent a gastric resection during the study period. Thirteen were prophylactic resections for E-cadherin gene mutations and 64 were for malignancy. The overall postoperative complication rate was 34%, with an anastomotic leak rate of 8% (n = 6). The 30-day readmission rate, 30-day mortality rate and 90-day mortality rate were 17%, 1%, and 5% respectively. No sociodemographic differences were identified in each outcome. An increasing day-4 CRP trajectory was observed in patients with an anastomotic leak. Postoperative complications and nodal disease were independent prognostic factors for reduced survival. Textbook outcome, postoperative complications, and readmission are validated quality performance indicators of gastric cancer surgery. Postoperative complications are associated with poor overall survival independent of severity or type. The underlying mechanisms of this influence remain elusive. The aggressive biology of gastric cancer, combined with the surgical morbidity and its negative influence on survival, highlights the importance of ongoing quality improvement.

Clinical observation of laparoscopic seromuscular dissection in the treatment of gastric stromal tumors

Objective To investigate the safety and oncological prognosis of laparoscopic seromuscular dissection (LSD) in the treatment of gastric stromal tumors. Material and methods From June 2016 to July 2022, 67 patients with gastric stromal tumors underwent laparoscopic seromuscular dissection (LSD), and 58 patients underwent non-LSD surgery during the same period (52 patients underwent laparoscopic gastric wedge resection (LWR), two patients underwent proximal gastrectomy, three patients underwent total gastrectomy, one patient underwent distal gastrectomy and partial hepatectomy). Gastric stromal tumor patients were compared to compare the surgical results, tumor relapse rate, and survival rate of the two groups. Results The results of the two groups were compared. For gastric stromal tumors, especially gastric stromal tumors located at ‘difficult sites’, LSD can reduce the amount of bleeding and the number of cutting staplers used during the operation, reduce the incidence of postoperative complications, shorten the postoperative hospitalization time, reduce the hospitalization cost and improve the quality of life of patients without increasing the operation time. Conclusion Laparoscopic seromuscular dissection for gastric stromal tumors is safe and technically feasible in the hands of experienced laparoscopic surgeons.

Surgical treatment of acute complicated duodenal ulcers

Complications of peptic ulcer of the stomach and duodenum are an integral part of urgent abdominal surgery. This especially applies to complications of duodenal ulcers (DU), which, in turn, is associated with a combination of several complications and problems with the choice of surgical tactics for their treatment. This is supported by postoperative mortality rates, which remain high and range from 15.0% to 68.0% according to various sources. The aim was to improve the results of treatment of complicated duodenal ulcers. The results of the analysis of surgical treatment of acutely complicated duodenal ulcers (combination of 3 and/or 4 combined complications) for 2 periods are presented: 1st – from 2000 to 2014 (group A) – 69 patients; 2nd – from 2015 to 2022 (group B) – 50 patients. 119 (100.0%) patients were operated on for complicated duodenal ulcers, of which 101 (84.9%) patients had a combination of three complications, and 18 (15.1%) – four complications. Out of 119 patients, 106 (89.1%) had bleeding complications. Complications of ulcer perforation in 53 (44.5%). Based on the obtained analysis data, there is a steady trend towards an increase in the rate of organ-preserving operations by 1.62 times (from 50.7% to 82%), a decrease in the number of gastric resections by 2.7 times (from 15.9 % to 6%). The number of performed organ-sparing operations was relatively stable: in group A – 15 (21.7%), in group B – 10 (20%). The use of modern measures of endoscopic hemostasis made it possible to implement a system of preparing patients for surgery, to operate on patients in the early delayed period, and their share from the first period to the second increased by 3.2 times (from 5.7% to 18.3%). The number of patients who underwent emergency surgery with ulcer perforation and bleeding as combined complications decreased in the second period compared to the first by 2.8 times, which is associated with the widespread use of mo­dern proton pump inhibitors in the conservative treatment of DU. Actively individualized tactics and the use of developed algorithms for choosing the type of surgical intervention made it possible to reduce the mortality rate by almost 2 times: from 16.8% in the first period (group A) to 8.9% in the second period (group B). Keywords: perforation, bleeding, stenosis, penetration, vagotomy, gastric resection.

Efficacy and cost-effectiveness of a novel dual gasping forceps-assisted over-the-scope clip inverted closure after gastric endoscopic full-thickness resection.

Efficacy and cost-effectiveness of a novel dual gasping forceps-assisted over-the-scope clip inverted closure after gastric endoscopic full-thickness resection.

3D versus 2D laparoscopic distal gastrectomy in patients with gastric cancer: a systematic review and meta-analysis.

While laparoscopic gastrectomy is a prominent therapeutic approach for distal gastric cancer, the clinical benefits of 3D laparoscopy over 2D laparoscopy remain unclear. We aimed to compare the clinical outcomes of 3D laparoscopy and 2D laparoscopy for distal gastric cancer resection through a systematic review and meta-analysis. We searched PubMed/MEDLINE, EMBASE, and Cochrane Library databases for studies published from inception through January 2023, according to the PRISMA guidelines. The MD or RR was used to compare 3D and 2D distal gastrectomy. Random-effects meta-analysis was estimated using the inverse variance and Mantel-Haenszel method for binary outcomes and the DerSimonian-Laird estimator for continuous outcomes. After reviewing 559 studies, 6 manuscripts met the inclusion criteria. The analysis included 689 patients, with 348 (50.5%) in the 3D group and 341 (49.5%) in the 2D group. 3D laparoscopic gastrectomy reduces the operative time (WMD - 28.57min, 95% CI - 50.70 to - 6.44, p = 0.011), intraoperative blood loss (WMD - 6.69mL, 95% CI - 8.09 to - 5.29, p < 0.001), and postoperative hospital stay (WMD - 0.92days, 95% CI - 1.43 to - 0.42, p < 0.001). There were no significant differences in time to first postoperative flatus (WMD - 0.22days, 95% CI - 0.50 to 0.05, p = 0.110), postoperative complications (Relative Risk 0.56, 95% CI 0.22 to 1.41, p = 0.217), and the number of retrieved lymph nodes (WMD 1.25, 95% CI - 0.54 to 3.03, p = 0.172) between 3 and 2D laparoscopic distal gastrectomy. Our study highlights the potential advantages of 3D laparoscopy in distal gastrectomy, including shorter operative time, postoperative hospital stay, and decreased intraoperative blood loss.

Safety and efficacy of direct percutaneous endoscopic jejunostomy placement in patients with previous upper gastrointestinal resection: A retrospective cohort study.

Percutaneous jejunal enteral access can be obtained with percutaneous endoscopic gastric jejunostomy (PEGJ) and direct percutaneous endoscopic jejunostomy (DPEJ) tubes. PEGJ may not be feasible in patients with previous gastric resection (PGR) and DPEJ may be the only option. Our aim is to determine if DPEJ tubes can be placed successfully in patients with history of gastrointestinal (GI) surgery and if success rates are comparable to DPEJ or PEGJ in those without prior GI surgery. We reviewed all tube placements performed from 2010 to present. Procedures were performed using a pediatric colonoscope. Previous upper GI surgery was defined as PGR or esophagectomy with gastric pull-up. Adverse events (AEs) were graded perAmerican Society for Gastrointestinal Endoscopy criteria. Mild events included unplanned medical consultation or hospitalization <3 days, and moderate events included repeat endoscopy without surgical intervention. Successful placement rates were high regardless of GI surgical history. Patients receiving a DPEJ with a history of GI surgery were significantly less likely to experience an AE compared with those receiving DPEJ with no history and compared with PEGJ patients with or without a history. DPEJ placement in patients with previous upper GI surgery has very high success rate. It is associated with lower AE rates than patients receiving DPEJ without previous gastric surgery, or PEGJ regardless of previous gastric surgery. Patients with a history of upper GI surgery requiring enteral access may benefit from DPEJ over PEGJ placement considering its very high success rate and lower incidence of AEs.

Weekday-dependent long-term outcomes in gastrointestinal cancer surgery: a German population-based retrospective cohort study.

For most solid cancers, surgery represents the mainstay of curative treatment. Several studies investigating the effects of the weekday of surgery (WOS) on patient outcomes have yielded conflicting results. Barmer, the second-largest health insurance company in Germany, serves roughly 10% of the German population. The authors have used the Barmer database to evaluate how the weekday on which the surgery is performed influences long-term oncologic outcomes. For this retrospective cohort study, the Barmer database was used to investigate the effect of the WOS (Monday-Friday) on outcomes following oncological resections of the colorectum ( n =49003), liver ( n =1302), stomach ( n =5027), esophagus ( n =1126), and pancreas ( n =6097). In total, 62555 cases from 2008 to 2018 were included in the analysis. The endpoints were overall survival (OS), postoperative complications, and the necessity for therapeutic interventions or reoperations. The authors further examined whether the annual caseload or certification as a cancer center influenced the weekday effect. The authors observed a significantly impaired OS for patients receiving gastric or colorectal resections on a Monday. Colorectal surgery performed on Mondays was associated with more postoperative complications and a higher probability of reoperations. The annual caseload or a certification as a colorectal cancer center had no bearing on the observed weekday effect. There is evidence that hospitals schedule older patients with more comorbidities earlier in the week, possibly explaining these findings. This is the first study investigating the influence of the WOS on long-term survival in Germany. Our findings indicate that, in the German healthcare system, patients undergoing colorectal cancer surgery on Mondays have more postoperative complications and, therefore, require significantly more reoperations, ultimately lowering the OS. This surprising finding appears to reflect an attempt to schedule patients with higher postoperative risk earlier in the week as well as semi-elective patients admitted on weekends scheduled for surgery on the next Monday.

Domestic scientists who made a significant contribution to the study of the digestive system diseases: images in art. Olexander Oleksiyovych Shalimov

Olexander Oleksiyovych Shalimov (1918—2006), Academician of the Academy of Sciences of the Ukrainian SSR, Hero of Socialist Labor, laureate of the State Awards of the USSR and the Ukrainian SSR, an Honorary Doctor of the RSFSR, an Honorary Scientist of the Ukrainian SSR, and a famous Soviet scientist and surgeon. He made a great contribution to the development of scientific and practical surgery and to the training of highly qualified personnel.The years spent working in Kharkiv marked the beginning of O. O. Shalimov’s scientific career. The range of his research interests was unusually wide and covered the surgery of the digestive organs, the heart, the main vessels, anesthesiology, resuscitation, etc. Together with his students, he developed and improved techniques for surgical treatment of diseases of the esophagus, peptic ulcer of the stomach and duodenum, liver, and biliary tract. He developed and put into practice a number of original techniques of surgical interventions, such as methods of esophagoplasty, pylorus‑preserving gastric resection, suturing of the duodenal stump, and rational methods of bile duct plastic surgery. O. O. Shalimov made a particularly great contribution to pancreatic surgery. He proposed a new technique of pancreatoduodenal resection for pancreatic cancer and a number of surgeries for the treatment of various forms of chronic pancreatitis.The Kyiv period of O. O. Shalimov’s life was characterized by further in‑depth study of diseases of the digestive and cardiovascular systems and the development of methods for their surgical treatment, the widespread introduction of the results of scientific developments into healthcare practice, and active work to improve surgical care for the population of the republic. The Institute headed by him (the leading institution in the republic in the field of surgery) had become not only one of the leading surgical institutions in the state but also a school of highly qualified personnel and a medical advisory, organizational, and methodological center of Ukraine. The result of the activity of O. O. Shalimov is that Ukraine has become a leader in the application of organ‑preserving surgeries at present.The works by O. O. Shalimov on pancreatic surgery are of particular interest. For many years, this organ was considered inaccessible to surgeons, since the resulting complications, as a rule, nullified all the efforts of surgeons. O. O. Shalimov was one of the path‑breakers in the development of techniques for the surgical treatment of pancreatic diseases. He devoted more than four decades to this work, achieving significant success and gaining high prestige as a pancreatic surgeon. The research results by O. O. Shalimov are reflected in 712 publications, including 24 monographs and three atlases. He was the author of 92 inventions. There are more than 40 doctors and 80 candidates of sciences among the numerous students of O. O. Shalimov.

Аналіз ефективності впливу баріатричних втручань у жінок із морбідним ожирінням і відновлення в них менструальної та репродуктивної функції

Purpose - to evaluate the effectiveness of weight loss after bariatric surgery (BS) in women with morbid obesity (MO) on the recovery of menstruation and the realization of reproductive functions. Materials and methods. Changes in menstrual and reproductive functions were analyzed in 51 women with MO and accompanying metabolic syndrome (MS), aged 22 to 55 years, who underwent BV. Women with a higher body mass (BMI) underwent biliopancreatic bypass (BPS) in the Hess-Marceau modification (I clinical group - 21 women), patients with a lower body mass index (BMI) - longitudinal gastric resection (LGR) - II clinical group (30 patients). The duration of observation in the postoperative period ranged from 3 to 7 years. The BMI of women ranged from 29.2 kg/m2 to 62.1 kg/m2 and averaged 44.0±1.0 kg/m2. The experience of obesity varied from 5 to 21 years. Results. Menstrual cycle disorders (MC) were observed in 100% of cases. 16 out of 24 (66.7%) women under the age of 40 had reproductive plans (RP) in the postoperative period. In 18 (75.0%) of them, we were talking about chronic anovulatory cycles. Endometrial and myometrial pathology was noted in 14 (27.5%) women. Analysis of the dynamics of MO indicators during the first 3 years after BS showed general trends towards a probable (p&lt;0.001) decrease in BM and BMI indicators in patients of all clinical groups already after 3 months from the start of treatment. Regular MC in women under 40 years of age was restored within 1.5 years against the background of a decrease in MT without medical intervention. Spontaneous pregnancy occurred in 7 (43.8%) women with RP 3 years after BS and in 5 (31.3%) - with the help of assisted reproductive technologies. Conclusions. An intense decrease in body weight and, accordingly, BMI, is observed within 12 months after operative treatment using the combined BPS method and in the period of 3-6 months in patients after PRS. Achieving statistical comparability of BMI indicators in both groups (p&gt;0.05) occurs already after 6 months. Stabilization of average BMI indicators in subsequent years occurs in the range (95% CI) of 25.7 - 32.1 kg/m2, regardless of the method of surgical intervention. Weight loss improved reproductive potential in women with MS by 42%. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Comparison of the effects of remimazolam and dexmedetomidine on early postoperative cognitive function in elderly patients with gastric cancer.

To compare the effects of remimazolam and dexmedetomidine on early postoperative cognitive dysfunction (POCD) in aged gastric cancer patients. From June to December 2022, 104 elderly patients (aged 65-80 years) received laparoscopic radical resection of gastric cancer at the First Affiliated Hospital of Nanchang University. Using the random number table approach, the patients were separated into three groups: remimazolam (Group R), dexmedetomidine (Group D), and saline (Group C). The primary outcome was the incidence of POCD, and secondary outcomes included TNF-α and S-100β protein concentrations, hemodynamics, VAS scores, anesthesia recovery indicators, and the occurrence of adverse events within 48 h postoperatively. At 3 and 7 days after surgery, there were no statistically significant differences in the incidence of POCD, the MMSE and MoCA scores between groups R and D (p > 0.05). However, compared to the saline group, both groups had higher MMSE and MoCA scores and decreased incidences of POCD. These differences were statistically significant (p < 0.05). Between group R and group D, there were no statistically significant changes (p > 0.05) in the levels of TNF-α and S-100β protein at the three time points (at the end of the surgery, 1 day later, and 3 days later). Even though neither group's concentration of the two factors was as high as that of the saline group, the differences were statistically significant (p < 0.05). At all three time points-following induction (T2), 30 min into the operation (T3), and at the conclusion of the surgery (T4)-the heart rate and blood pressure in group R were greater than those in groups D and C. Statistics showed that the differences were significant (p < 0.05). The incidence of intraoperative hypotension was highest in group D and lowest in group R (p < 0.05). The dose of propofol and remifentanil, group C > group R > group D. Extubation and PACU residence times did not differ statistically significantly (p > 0.05) between the three groups. There was no significant difference in VAS scores between groups R and D after 24 h postoperatively (p > 0.05), although both had lower scores than group C, and the difference was statistically significant (p < 0.05). The VAS scores between the three groups at 72 h (T6) and 7 days (T7) were not statistically significant (p > 0.05). Adverse reactions such as respiratory depression, hypotension, bradycardia, agitation, drowsiness, and nausea and vomiting had the lowest incidence in group R and the highest incidence in group C (p < 0.05). Remimazolam is similarly beneficial as dexmedetomidine in lowering the incidence of early POCD in aged patients after radical gastric cancer resection, probably due to reduced inflammatory response.

Predictors and Outcomes of Intraoperative Blood Transfusion in Cirrhotic Veterans

Background: Cirrhotic patients are at increased risk of postoperative complications and mortality following any surgical procedure. One of the independent predators of adverse outcomes is intraoperative transfusion (IOT). In this study we examine the profile of cirrhotic patients requiring IOT to determine its predictors.&#x0D; Methods: The Veterans Affairs Surgical Quality Improvement Program (VASQIP) was utilized to identify all patients with cirrhosis and ascites who underwent any non-liver transplant procedures from 2008 to 2015. Univariate and multivariate regression were used to identify predictors of increased risk of IOT and associated outcomes.&#x0D; Results: A total of 1,957 cirrhotic patients were identified, of which only 358 (18.8%) required IOT ≥1 unit. IOT group were older, more frail, higher Model for End-stage Liver Disease (MELD) score, anemic (hematocrit &lt;30%), hypoalbuminemic. This group also had more emergent procedures, higher rates of preoperative sepsis, longer operative time, longer postoperative length of stay, and higher morbidity and mortality rates. On multivariate logistic regression, pancreatic resections, open hernia repair, anemia, gastric resections, hypoalbuminemia, acute renal failure, emergency procedure, preoperative sepsis, and preoperative weight loss &gt;10% were significant predictors of IOT.&#x0D; Conclusion: IOT in cirrhotic patients is associated with worse outcomes. Pancreatic procedures, open hernia repair, and gastric resection were associated with increased IOT. This aid in preoperative planning and blood products preparation.

Monocyte-to-lymphocyte ratio as a determinant of survival in patients with gastric cancer undergoing gastrectomy: A cohort study.

The monocyte-to-lymphocyte ratio (MLR) is an important prognostic determinant of various malignancies. However, the prognostic role of MLR in patients with gastric cancer undergoing gastrectomy remains unclear. Patients with stage I to III gastric cancer who underwent curative-intent gastric resection were enrolled in this study. Cox regression analysis was used to determine the independent variables for overall survival (OS) and disease-free survival (DFS). The established models were validated internally. Inter-model comparisons were performed using the integrated area under the receiver operating characteristic curve and the concordance index. Multivariate Cox regression analysis revealed that age, tumor-node-metastasis (TNM) stage, perineural invasion, serum albumin level, and MLR were prognostic factors for OS and DFS and constituted the full model. The full model was internally validated using calibration curves and decision curve analysis. The integrated area under the curve and concordance index of the full model outperformed those of TNM stage. The full model was a significant determinant of OS and DFS. Additionally, the full model was suggested to outperform TNM stage in predicting patient survival outcomes.

Robotic Function-Preserving Resection of Gastric Gastrointestinal Stromal Tumor

IntroductionGastric gastrointestinal stromal tumors (GISTs) located at the gastroesophageal junction (GEJ), lesser curvature, posterior gastric wall, or antrum present challenges for gastric function preservation. The aim of this study was to evaluate safety and effectiveness of robot-assisted resection of gastric GIST in challenging anatomic locations. MethodsThis was a single-center case series of robotic gastric GIST resections in challenging anatomic locations performed from 2019 to 2021. GEJ GISTs are defined as tumors within 5 cm of the GEJ. Location of the tumor and distance from the GEJ were determined from the endoscopy report and/or cross-sectional imaging and operative findings. ResultsThere were 25 consecutive patients who underwent a robot-assisted partial gastrectomy for a gastric GIST in challenging anatomic locations. Tumors were located at the GEJ (n = 12), lesser curvature (n = 7), posterior gastric wall (n = 4), fundus (n = 3), greater curvature (n = 3), and antrum (n = 2). Median distance of tumor from GEJ was 2.5 cm. Both GEJ and pylorus were successfully preserved in all patients regardless of tumor location. Median operative time was 190 min with a median estimated blood loss of 20 mL and no conversion to open approach. Median hospital stay was 3 d with solid diet intake starting 2 d after surgery. Two (8 %) patients had Grade III or higher postoperative complications. Median tumor size upon resection was 3.9 cm. Negative margins were obtained in 96.3%. There was no evidence of recurrent disease with a median follow-up of 11.3 mo. ConclusionsWe demonstrate the safety and feasibility of using the robotic approach to facilitate function preservation gastrectomy in challenging anatomic locations without compromising oncologic resection.

Upregulation of XRCC1 DNA Repair Gene, Interleukin-8, and Bcl-2 Antiapoptotic Gene Levels in Kurdish Patients with Gastric Adenocarcinoma.

Gastric cancer (GC) is one of the deadliest tumors due to its competence to invade and metastasize. The DNA repair gene (XRCC1), interleukin-8 (IL-8) gene, and B-cell lymphoma 2 (Bcl-2) gene play a crucial role in the development and progression of GC. This study aimed to evaluate the expression of these target genes in GC patients in the Kurdistan region of Iraq. Gastric cancer tissues were collected from 29 patients diagnosed with gastric adenocarcinoma that underwent gastric resection, and 21 tissue samples were obtained from healthy patients that underwent gastroscopy. The gastric tissues were collected in different hospitals in Erbil and Sulaymaniyah cities in the Kurdistan region of Iraq. Moreover, the data regarding Helicobacter pylori, age, gender, and stage of the disease were recorded and analyzed using GraphPad Prism. The gene expression levels of XRCC1, IL-8, and Bcl-2 from gastric tissue were studied by real-time quantitative polymerase chain reaction. The results showed that H. pylori infection was equally distributed among males and females in the tissues of gastric patients, while most of the H. pylori-negative patients were females. It is also found that gastric patients aged 30-60 years old are more commonly tested for the H. pylori test. Accordingly, in this study, patients diagnosed with gastric inflammation more often tested positive for H. pylori, while patients diagnosed with gastric cancer tested negative for this infection. Additionally, it was found that the target genes (XRCC1, IL-8, and Bcl-2) were significantly upregulated in GC patients, compared to the healthy group. Finally, the result revealed that XRCC1, IL-8, and Bcl-2 were upregulated in the Kurdish patients with GC, compared to the healthy control group. Targeting XRCC1, IL-8, and Bcl-2 genes can be an interesting field and promising strategy for cancer treatment.

CURRENT PERSPECTIVES ON OPERATION MINIGASTROSHUNTING

Minigastric bypass is a relatively new bariatric operation that is an effective method for reducing body weight and controlling comorbidities. In minigastric bypass, a thin, narrow tube similar to the gastric sleeve in longitudinal gastric resection is excised from the stomach and a single anastomosis is placed between this sleeve and a loop of small intestine. About two metres of the small intestine is disconnected from digestion.

Comparative Analysis of NSQIP National Outcomes and Projected Outcomes versus Our Institutional Outcomes for Robotic Gastrectomy: The Future of Gastric Resection.

The robotic approach has vast applications in surgery; however, the utility of robotic gastrectomy has yet to be clearly defined. This study aimed to compare outcomes following robotic gastrectomy at our institution to the national patient-specific predicted outcomes data provided by the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP). We prospectively studied 73 patients who underwent robotic gastrectomy under our care. ACS NSQIP outcomes after gastrectomy and predicted outcomes for our patients were compared with our actual outcomes utilizing students t test and chi-square analysis, where applicable. Data are presented as median (mean ± SD). Patients were 65 (66 ± 10.7) years old with a BMI of 26 (28 ± 6.5) kg/m2. 35 patients had gastric adenocarcinomas and 22 had gastrointestinal stromal tumors Operative duration was 245 (250 ± 114.7) minutes, estimated blood loss was 50 (83 ± 91.6) mL, and there were no conversions to 'open'. 1% of patients experienced superficial surgical site infections compared to the NSQIP predicted rate of 10% (P < .05). Length of stay (LOS) was 5 (6 ± 4.2) days vs NSQIP's predicted LOS of 8 (8 ± 3.2) days (P < .05). Three patients died during their postoperative hospital course (4%), due to multi-system organ failure and cardiac arrest. 1-year, 3-year, and 5-year estimated survival for patients with gastric adenocarcinoma was 76%, 63%, and 63%, respectively. Robotic gastrectomy yields salutary patient outcomes and optimal survival for varying gastric diseases, particularly gastric adenocarcinoma. Our patients experienced shorter hospital stays and reduced complications relative to patients in NSQIP and predicted outcome for our patients. Gastrectomy undertaken robotically is the future of gastric resection.

Conservative Treatment about Two Cases of Caustic Burns of the Upper Digestive Tract in Adults at the Sominé Dolo Hospital in Mopti

Emergency gastrointestinal endoscopy for patients who have ingested a caustic substance may overestimate burn injury and lead to unnecessary gastric resection. Caustic gastric lesions of stage III, without immediate life threat, do not systematically require an emergency total gastrectomy. This work was to evaluate the results of a conservative attitude of gastric stage III in two patients, by only proposing surgery in the presence of clinical, biological and radiological signs of severity. Reconstructive surgery and/or endoscopic dilation may be considered depending on the occurrence of strictures. We report two cases of caustic burn of the upper digestive tract in adults at the Sominé Dolo hospital in Mopti. Both patients were referred for surgery for partial gastrectomy with gastro - entero -anastomosis. The postoperative follow-up was simple and an endoscopic control carried out on D 15 and D 30 postoperatively did not find any obstacle at the level of the anastomoses. Cardial stenosis benefited from dilation sessions at a rate of 21 days until satisfaction.

The risk of osteoporotic fracture in gastric cancer survivors: total gastrectomy versus subtotal gastrectomy versus endoscopic treatment.

Previous studies have suggested that there is an increased risk of osteoporotic fracture in gastric cancer survivors. However, the data was not classified according to surgery type. This study investigated the cumulative incidence osteoporotic fracture (OF) in gastric cancer survivors according to treatment modality. A total of 85,124 gastric cancer survivors during 2008-2016 were included. The type of surgery was classified as total gastrectomy (TG, n = 14,428)/subtotal gastrectomy (SG, n = 52,572)/endoscopic mucosal dissection and endoscopic mucosal resection (ESD/EMR, n = 18,125). The site of osteoporotic fractures included the spine, hip, wrist, and humerus. We examined cumulative incidence using Kaplan-Meier survivor analysis and cox proportional hazards regression analysis to determine the risk factor of OF. The incidence of OF per 100,000 patient year was 2.6, 2.1, 1.8 in TG, SG, ESD/EMR group. The cumulative incidence rate was 2.3% at 3years, 4.0% at 5years, and 5.8% at 7years in gastrectomy group, and 1.8% at 3years, 3.3% at 5years in the SG group, and 4.9% at 7years postoperatively in ESD/EMR group. TG increased the risk of OF compared to patients who underwent SG (HR 1.75, 95% confidence interval [CI] 1.57-1.94), and ESD/EMR (hazard ratio [HR] 2.23, 95% CI 2.14-2.32). Gastric cancer survivors who underwent TG had an increased osteoporotic fracture risk than did SG or ESD/EMR in these patients. The amount of gastric resection and accompanying metabolic changes seemed to mediate such risk. Additional research is needed to establish an optimal strategy for each type of surgery.