Ann Surg Treat Res.  2017 Dec;93(6):305-309. 10.4174/astr.2017.93.6.305.

Laparoscopic reinforcement suture on staple-line of duodenal stump using barbed suture during laparoscopic gastrectomy for gastric cancer

• Kim SY
• Nam SH
• Min JS
• Kim MC

• KMID: 2396871
• DOI: http://doi.org/10.4174/astr.2017.93.6.305

Abstract

PURPOSE
Duodenal stump fistula (DSF) is a serious complication after gastrectomy for gastric cancer. Although risk evaluation and management of DSF were presented by some investigators, there was no technical attempt has been made to prevent DSF during laparoscopic gastrectomy until now.
METHODS
Consecutive 99 patients were enrolled from April 2014 to February 2016 in 2 institutes. All patients were performed laparoscopic gastrectomy for gastric cancer. After cutting of duodenal stump, laparoscopic reinforcement suture (LARS) commenced with continuous invagination method or interrupted method by barbed suture. Clinicopathologic features and postoperative outcomes were analyzed.
RESULTS
Fifty-six patients had comorbidity including 5 patients with duodenal ulcer. Most patients were performed distal gastrectomy with B-II, and 10 patients total gastrectomy with Roux en Y esophagojejunostomy. Although there were 2 esophagojejunostomy leakage and 1 artificial lesser curvature leakage, DSF did not occurred at all in this study. Mean operation time was 3 hours and mean LARS procedure time was 8 minutes.
CONCLUSION
LARS of duodenal stump can be considered as one of prevention methods of DSF during laparoscopic gastrectomy for gastric cancer. So this new technique will be necessary to appropriately evaluate by prospective randomized controlled trial in the future.

Keyword

Laparoscopy; Gastrectomy; Reinforcement; Duodenum; Leakage

MeSH Terms

Academies and Institutes
Comorbidity
Duodenal Ulcer
Duodenum
Fistula
Gastrectomy*
Humans
Laparoscopy
Methods
Prospective Studies
Research Personnel
Stomach Neoplasms*
Sutures*

Figure

• 

  Fig. 1 (A) Laparoscopic reinforcement suture (LARS) commence from upper to lower part on staple-line of duodenal stump using barbed suture. (B) Continuous suture with invagination is completed after 5 or 6 stitches.

• 

  Fig. 2 In case of patient with short duodenal stump because of chronic ulcer or ectopic pancreas at duodenal bulb or cancer invasion to pylorus, 2 or 3 interrupted sutures without invagination of duodenal stump is conducted using barbed sutures.

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  Fig. 3 Duodenal stump after Laparoscopic reinforcement suture (LARS) is presented at abdominal CT scan at postoperative 6 months. Arrow indicates invaginated duodenal stump.

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