Kolandasamy, C (2013) Short term and long term outcomes of stapled Versus handsewn oesophagojejunal anastomosis after Total Gastrectomy. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION : Surgery remains the mainstay of treatment for OG Junction carcinoma and proximal body gastric carcinoma, with chemotherapy and chemoradiotherapy as adjuvant or neoadjuvant treatment. The majority of gastric cancers are still diagnosed at an advanced stage. Total gastrectomy followed by D2 dissection offers the best prospects in term of overall survival. After the surgery, complications in terms of post operative morbidity and mortality are related to the oesophagojejunal anastomosis. Oesophagojejunal anastomosis is the Achilles heel of total gastrectomy. Since the introduction of the first mechanical stapling devices, a debate started about whether mechanical staplers or manual sutures produce better results. This debate continued well into the nineties, when very large studies settled the debate in favor of stapled anastomosis. Oesophagojejunostomy, using a circular stapler or hand sewn sutures, is a standard technique for Roux-en-Y reconstruction after total gastrectomy. Recently, mechanical anastomosis has been considered to be a safe way to create an oesophagojejunostomy, with leakage rates equivalent or even superior to those of hand-sewn anastomosis. Improvements in suturing techniques allowed improvement in the results of handsewn anastomosis, thereby previously described failure rates of about 15 percent no longer appropriate. AIM : To compare the short term and long term outcomes between stapled versus hand sewn oesophagojejunal anastomosis after total gastrectomy for OG junction carcinoma and proximal gastric carcinoma. To analyze the perioperative variables like duration of surgery, margins, postoperative day of initiating oral intake, incidence of anastomotic leakage, incidence of stricture, morbidity, mortality and hospital stay between the groups of patients undergoing mechanically stapled and hand sewn oesophago-jejunal anastomosis and improve the perioperative care to achieve good outcomes after total gastrectomy. CONCLUSION : In stapler group operative time and hospital stay were less and also statistically significant compared to hand sewn group. Anastomotic leakage in stapler group was less but not statistically significant compared to hand sewn group. RT removal, DT removal and post operative day of initiating oral intake were earlier and also statistically significant compared to hand sewn group. The data support the use of stapled esophagojejunal anastomosis as a safe way to create an oesophagojejunal anastomosis, it is quick to perform allowing shorter operating time and hospital stay and does not appear to be associated with a previously noted increased incidence of benign anastomotic stricture formation when compared with handsewn anastomoses.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Short term ; Long term outcomes ; stapled ; handsewn oesophagojejunal anastomosis ; total gastrectomy. |
| Subjects: | MEDICAL > Surgical Gastroenterology and Proctology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 27 Jul 2017 03:40 |
| Last Modified: | 27 Jul 2017 03:40 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/2215 |
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