[Value of automatic sutures in total gastrectomy for cancer: apropos of 81 patients].
We reviewed the results of stapled circular (EEA) and linear (TA 30 or 55) anastomoses in a prospective study of 40 total gastrectomies for cancer, using an interposed jejunal limb (Henley technique). There were 63 circular anastomoses: 40 esophago-jejunal, 20 jejuno-duodenal and 3 jejuno-jejunal anastomoses. Forty patients were submitted to 41 linear stapled closures of the jejunal stump. Technical failure rate with stapled anastomoses was 5% (3 out of 63). Incidence of anastomotic leak was 6.3% for all the circular stapled anastomoses tried and 5% if the 3 technical failures were excluded. Anastomotic leakage is more often associated to splenopancreatectomy. One patient (1% of all the anastomoses) presented gastro-intestinal bleeding, related to the suture line. A conservative treatment was carried out successfully. The mean follow-up time of the surviving patients was 27 +/- 20 months: there was a 5.5% rate of late anastomotic stenosis; all the patients were cured by esophageal dilations. Late anastomotic stenosis is directly related to associated cobalt therapy. Analysis of an older retrospective series of 41 hand-sutured total gastrectomies allowed a comparison to be made between stapled and sutured anastomoses in total gastrectomy for cancer.
D000328:Adult; D000368:Aged; D004937:Esophageal Fistula / Q000209:etiology; D004940:Esophageal Stenosis / Q000209:etiology; D005743:Gastrectomy / Q000379:methods*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007583:Jejunum / Q000637:transplantation; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D013528:Surgical Staplers; D013536:Suture Techniques
Apport de la suture automatique dans la gastrectomie totale pour cancer: à propos de 81 patients.