Shinsuke Hatori

Postoperative functional evaluation of pylorus-preserving gastrectomy for early gastric cancer compared with conventional distal gastrectomy.

BACKGROUND Malnutrition, gallbladder dysfunction, dumping syndrome, reflux esophagitis, and gastritis of the remnant stomach are unfavorable sequelae in patients undergoing gastrectomy. Operative procedures should be improved to ensure such patients a satisfactory quality of life. METHODS After operation, gallbladder function, reflux gastritis, gastric emptying, and caloric intake were evaluated in 20 patients with early gastric cancer undergoing pylorus-preserving gastrectomy (PPG) and 25 patients undergoing conventional distal gastrectomy (CDG). RESULTS The resting gallbladder area increased significantly after CDG. In contrast, after PPG the gallbladder area showed no significant change and the contraction rate decreased slightly. After CDG, emptying was much more rapid for the first 30 minutes after ingestion of a meal. Although delayed emptying was observed early after PPG, the rate of emptying increased with time. Gastric pH was lower and gastric mucosal injury was milder in patients undergoing PPG. These results are attributed to preserved pyloric function. The caloric intake and changes in body weight after operation were similar in both the CDG and PPG groups. CONCLUSIONS PPG has advantages over CDG in terms of gallbladder function, the condition of the remnant stomach, and gastric emptying, PPG should be used in carefully selected patients with early gastric cancer to improve their quality of life.

Video-assisted thoracoscopic esophagectomy with a voice-controlled robot: the AESOP system.

The authors attempted to clarify the feasibility and safety of thoracoscopic esophagectomy with a voice-controlled robot, the AESOP system (3000 HR), and further determine whether innovative surgical equipment could allow the performance of complex thoracoscopic esophagectomy. Thoracoscopic surgery with a voice-controlled robot system has already been used in single-surgeon lung resection. Intra-operative and postoperative outcomes were compared between patients receiving hand-assisted laparoscopic surgery (HALS) and video-assisted thoracoscopic surgery (VATS) with the AESOP system (n = 15) and patients receiving open surgery (n = 30). In the AESOP group, the volume of blood loss was significantly less, but the total operation time was longer than in the open group. There were no significant differences in postoperative outcomes or the incidences of morbidity and mortality between the two groups. The surgeon using the AESOP system could obtain a stable, close-up, and long-lasting operative view. Laparoscopic and thoracoscopic surgery with the AESOP system has the potential to enable a single surgeon to perform a complex surgical procedure like esophagectomy.

Effect of trypsin inhibitor on reflux oesophagitis after total gastrectomy in rats.

OBJECTIVE To characterise alkaline reflux oesophagitis after total gastrectomy in rats from the standpoints of cell proliferation and apoptosis and from its macroscopic and microscopic findings, and to evaluate the preventive and curative effects of camostat mesilate, a trypsin inhibitor. DESIGN Open laboratory study. SETTING University hospital, Japan. ANIMALS 70 male Wistar rats. INTERVENTIONS Total gastrectomy with Billroth II anastomosis (n = 30) and with Roux-en-Y anastomosis (n = 30) were used to establish reflux oesophagitis. Camostat mesilate was given for prevention and cure. The remaining 10 animals had a sham operation. MAIN OUTCOME MEASURES Trypsin activity of the oesophagus, macroscopic and microscopic findings, bromodeoxyuridine (BrdU) and apoptotic cell labelling indices. RESULTS Reflux oesophagitis was more common and extensive after Billroth II than Roux-en Y anastomosis. The BrdU labelling index was increased in oesophagitis, while the apoptotic index did not change. Camostat mesilate was effective in both preventing and treating oesophagitis. CONCLUSION Trypsin has an important role in the development of reflux oesophagitis after total gastrectomy.

Gastric emptying after pylorus-preserving gastrectomy in comparison with conventional subtotal gastrectomy for early gastric carcinoma.

It is well known that surgical intervention on the stomach will greatly alter gastric function and gastric emptying. In this study, we evaluated the difference in postoperative gastric remnant emptying following pylorus-preserving gastrectomy (PPG) and conventional subtotal gastrectomy (CDG) using sulfamethizole capsule food. The subjects comprised 18 patients who underwent PPG and 23 who underwent CDG for early gastric carcinoma. While delayed gastric emptying was observed early after PPG, 1 year after PPG it was markedly accelerated compared with that measured in the early postoperative period. However, it was slower than that in the CDG patients. On the other hand, rapid gastric emptying was observed early after CDG and did not change with time. These findings stress that although PPG results in stasis in the early postoperative period, it seems to prevent unduly rapid emptying.

Easy method for fixation of the anvil using a one-handed sliding-knot technique after laparoscopic total gastrectomy.

When esophagojejunostomy is performed using a circular stapler after laparoscopic total gastrectomy, fixing the anvil to the end of the esophagus is challenging. We describe an easy method for fixation of the anvil using a one‐handed sliding‐knot technique after the anvil has been inserted into the esophagus.