title: Usefulness of T-Shaped Gauze for Precise Dissection of Supra-Pancreatic Lymph Nodes and for Reduced Postoperative Pancreatic Fistula in Patients Undergoing Laparoscopic Gastrectomy for Gastric Cancer.
abstract: BACKGROUND
  Supra-pancreatic lymph node dissection is important in patients undergoing laparoscopic gastrectomy (LG) for gastric cancer. A clear view of the supra-pancreatic area is necessary for precise dissection of supra-pancreatic lymph nodes without injury to the pancreas. This retrospective study assessed the efficacy of T-shaped gauze (TSG) in retracting the pancreas during supra-pancreatic lymph node dissection.
  
  
  METHODS
  The study cohort consisted of 80 patients who underwent LG for gastric cancer. Of these, 44 patients underwent pancreatic retraction with TSG (TSG group) and 36 without TSG (non-TSG group). The efficacy of TSG for pancreatic retraction was evaluated by comparing all grade and Clavien-Dindo grade ≥ III postoperative pancreatic fistula (POPF) and the total number of dissected supra-pancreatic lymph nodes in the TSG and non-TSG groups.
  
  
  RESULTS
  The rates of all grade (6.8% vs. 11%) and of Clavien-Dindo grade ≥ III (2.2% vs. 5.5%) POPF were lower in the TSG than in the non-TSG group. The total number of supra-pancreatic lymph nodes harvested by Dissection 1+ (D1+) lymph node dissection was significantly higher in TSG than in non-TSG patients (P= 0.0078).
  
  
  CONCLUSIONS
  TSG may be useful for safe and efficient performance of supra-pancreatic lymph node dissection.
authors.affiliation: Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Matsunaga
authors.affiliation: Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Saito
authors.affiliation: Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Murakami
authors.affiliation: Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Kuroda
authors.affiliation: Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
authors.forename: Yoji
authors.initials: Y
authors.lastname: Fukumoto
authors.affiliation: Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Osaki
keywords: T-shaped gauze; gastric cancer; laparoscopic gastrectomy; postoperative pancreatic fistula