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Introduction. Gastric cancer remains among the top three digestive diseases with the highest mortality rates in the world. Treatment of gastric cancer is multidisciplinary, gastric resection being essential for the best result. Anemia is one of the most common comorbidities present in patients diagnosed with gastric cancer. Materials and Methods. This is a retrospective analytical study over a period of 6 years (2014-2019). It is based on 114 consecutive gastric resections for cancer performed by a single team using exclusively resection and reconstruction stapling methods. The study aims to investigate a correlation between the presence of preoperative anemia and the incidence of postoperative morbidity and mortality. Results. Preoperative anemia was found in 70% of patients, with about half of these patients presenting with mild anemia. Most postoperative complications were grade I and II according to the Clavien Dindo scale. Anemia was correlated with an increase in infectious complications, anastomotic leaks and secondary peritoneal abscesses, pancreatic complications after multivisceral resection and length of hospital stay. Conclusions. Preoperative anemia is a risk factor that exposes the cancer patient to an increased incidence of life-threatening postoperative complications. In addition, it also extends the length of hospital stay and costs. Therefore, special attention should be paid to the identification and reduction of anemia before extensive gastric surgery in order to obtain the best possible therapeutic result.

The analysis of the results of treatment of 97 patients who were operated from surgical diseases of the cardiac stomach. Proximal gastric resection (PRG) was performed using isoperistaltic jejunogastroplasty (modified by Merendino-Dillard) (50 people – group I) and with direct esophagogastroanastomosis (47 people – group II). 12 and 24 months after the operation, an X-ray and endoscopic examination of the upper digestive tract was performed, assessing the severity of functional disorders (nutritional status, body weight deficiency, reflux esophagitis, anastomosis) Results. After 2 years or more, 5.9% of patients ate more than 6 times a day in group I, while in group II, 23.3% (p

In patients with Roux-en-Y (RY) reconstruction for gastric resection, the newly defined "fold disruption" (FD) sign can be useful to distinguish the afferent limb from the efferent limb at the Y anastomosis when balloon endoscopy-assisted endoscopic retrograde cholangiopancreatography (BE-ERCP) is performed. The FD sign was defined as endoscopic findings of the internal folds disrupted toward the afferent limb and continued toward the efferent limb at the Y anastomosis. In this prospective observational study, the accuracy of the FD sign was evaluated for those who underwent BE-ERCP after gastric resection with RY reconstruction. Of 28 patients for whom the accuracy could be evaluated among 30 enrolled patients, the afferent limb was identified using the FD sign with 100% accuracy. For the other two patients, the scope could not reach the target lumen due to severe intestinal adhesion in one and reached the target lumen without recognition of the Y anastomosis in the other. There was no patient for whom the FD sign could not be judged for any reason, such as a blurred anastomosis line, unclear folds, sticky discharge and blood coating the surface, when the Y anastomosis was recognized. The FD sign was a highly accurate tool for distinguishing the afferent limb from the efferent limb in patients after gastric resection with RY reconstruction. This study was registered in UMIN (issued ID, UMIN000038326).

Gastric resection in high ulcers can often be difficult. The removal of up to two-thirds of the stomach, according to Finsterer, is undesirable, and the imposition of an anastomosis on the part of the stomach, hidden in the left hypochondrium, seems to be a rather serious intervention.

The article presents the literature data and the results of the author’s own research on the development of peptic ulcer surgery in the historical aspect. It is shown that the evolution of the knowledge about the etiopathogenesis of peptic ulcer influenced the development of methods for surgical interventions. The main periods of development of peptic ulcer surgery are identified: the first period (1842–1881) — the time of the formation of gastric surgery; the second period (1880–90s) — the time of gastric surgery becoming an independent clinical discipline; the third period (the end of the 19th century — 1920s) — the time of peptic ulcer surgery development, when gastroenterostomy was the method of choice in surgical treatment; the fourth period (1930–60s) — the time when the pathogenetic principles of peptic ulcer surgery appeared; gastric resection served as a method of choice; the fifth (the final) period (1970–90s — present time) — the summing up of the 150-year history of ulcer surgery, when doctors tend to conservative treatment of this complex pathology, and surgical intervention in peptic ulcer is directed only to сorrection of disease complications, without destroying the digestive system. It is shown that the historical experience, the thorny path of hopes and disappointments that doctors have taken when searching an optimal approaches to the surgical treatment of peptic ulcer, will help surgeons, therapists, morphologists and physiologists in the future.

Background and objectives: Gastric cancer (GC) is often diagnosed in the metastatic stage. Palliative systemic therapy is still considered the gold standard, even for patients with resectable oligometastatic disease. The aim of the current study is to assess the potential benefit of up-front gastric and liver resection in patients with synchronous resectable liver-only metastases from GC (LMGC) in a Western population. Materials and Methods: All patients with GC and synchronous LMGC who underwent gastric resection with or without simultaneous resection of LMs between January 1997 and December 2016 were selected from the institutional records. Those with T4b primary tumors or with unresectable or more than three LMs were excluded from the analysis. All patients who underwent emergency surgery for hemorrhagic shock or gastric perforation were also excluded. Results: Out of 28 patients fulfilling the inclusion criteria, 16 underwent simultaneous gastric and liver resection (SR group), while 12 underwent palliative gastric resection (GR group). The median overall survival (OS) of the entire cohort was of 18.81 months, with 1-, 3- and 5-year OS rates of 71.4%, 17.9% and 14.3%, respectively. The 1-, 3- and 5-year OS rates in SR group (75%, 31.3% and 25%, respectively) were significantly higher than those achieved in GR group (66.7%, 0% and 0%, respectively; p = 0.004). Multivariate analysis of the entire cohort revealed that the only independent prognostic factor associated with better OS was liver resection (HR = 3.954, 95% CI: 1.542–10.139; p = 0.004). Conclusions: In a Western cohort, simultaneous resection of GC and LMGC significantly improved OS compared to patients who underwent palliative gastric resection.

In order to improve the results of stomach resection and to avoid postgastroresection syndromes the authors propose a procedure of forming terminolateral anastomosis elaborated and introduced into practice by them which insures a portioned-rhythmic evacuation of the gastric contents., Для покращання результатів резекції шлунка, запобігання розвитку постгастрорезекційних синдромів пропонується розроблений та впроваджений у практику спосіб формування термінолатерального анастомозу, який забезпечує порційно-ритмічну евакуацію шлункового вмісту.

Forpatients with Localized Gastric Cancer(T1-4, N0-3, M0) the oncologic resection of the tumoris the only potentially curative treatment. The oncologic resection is necessary to achieve two objectives: a) Extirpation of the tumorwith free margins and b) Resection of regional lymph nodes. Due to the heterogeneity of gastric cancer, the type of gastric resection (mucosectomy, gastrectomy orextended gastrectomy) and lymphadenectomy (D2, D1, D2) depends of the depth of invasion of the gastric wall and the possibility of lymph node metastases. Therefore, using all methods of diagnosisthe ,clinical TNM (cTNM) has to be established in the pre-operative period in orderto perform a stage oriented resection.

Ovarian cancer represents one of the most aggressive gynecological malignancies affecting women worldwide, associated with significant rates of cancer related death within the first years after the initial diagnostic. The poor survival rates are usually explained by the presence of disseminated lesions even from the beginning. In such situations, the digestive tube is one of the most commonly involved territory, therefore necessitating extended resections in order to achieve complete cytoreduction. The aim of this paper is to report the case of a 53 year old patient who was diagnosed with peritoneal carcinomatosis from ovarian cancer, presenting multiple levels of digestive tract involvement due to the presence of disseminated tumoral masses. Therefore the patients was submitted to multiple digestive resections represented by parcelar gastrectomy, segmental ileal resection and subtotal colectomy. In order to minimize the risks of developing severe postoperative complications – due to the relatively high number of anastomoses – the continuity of the digestive tract was established by a terminal ileostomy, considering that creation of a ileorectal anastomosis would be too dangerous in the context of multiple digestive resections. The postoperative evolution was simple, the patient being further submitted to adjuvant treatment.

Background Perforated gastric ulcers are surgical emergencies with paucity of data on the preferred treatment modality of resection versus omental patch. We aim to compare outcomes with ulcer repair and gastric resection surgeries in perforated gastric ulcers after systematic review of literature. Methods A systematic literature search was performed for publications in PubMed Medline, Embase, and Cochrane Central Register of Controlled Trials. We included all studies which compared ulcer repair vesus gastric resection surgeries for perforated gastric ulcers. We excluded studies which did not separate outcomes gastric and duodenal ulcer perforations. Results The search included nine single-institution retrospective reviews comparing ulcer repair (449 patients) versus gastric resection surgeries (212 patients). Meta-analysis was restricted to perforated gastric ulcers and excluded perforated duodenal ulcers. The majority of these studies did not control for baseline characteristics, and surgical strategies were often chosen in a non-randomized manner. All of the studies included were at high risk of bias. The overall odds ratio of mortality in ulcer repair surgery compared to gastric resection surgery was 1.79, with 95% CI 0.72 to 4.43 and p-value 0.209. Conclusion In this meta-analysis, there was no difference in mortality between the two surgical groups. The overall equivalence of clinical outcomes suggests that gastric resection is a potentially viable alternative to ulcer repair surgery and should not be considered a secondary strategy. We would recommend a multicenter randomized control trial to evaluate the surgical approach that yields superior outcomes. Level of evidence Systematic review and meta-analysis, level III.

Intussusception is one of the varieties of mixed (strangulation and obturation) mechanical intestinal obstruction. It arises as a result of the introduction of the adducting segment of the intestine into the abducting one. Gastroduodenal intussusception is an extremely rare type of high intestinal obstruction. It most often occurs after surgery on the stomach and much less often in non-operated patients. Intussusception of the jejunum into the stomach can occur soon after surgery, but most often, this complication occurs 515 years after the intervention. This paper describes a case of retrograde intussusception that arose 9 years after the Billroth II gastric resection with Braun anastomosis. This clinical case acquaints specialists with the possibility to encounter this pathology in clinical practice and demonstrates the appropriateness of differential diagnostics in cases with similar clinical symptoms.

In weakened and emaciated gastric cancer patients who have been radically operated on, in the immediate postoperative period, quite often a number of complications are noted. The most common congestion in the cult of the stomach and duodenum - expansion of the stomach stump and stasis of the duodenum.

Minimally invasive surgical techniques with respect to the treatment of gastric cancer have progressed rapidly over the last few years. Especially in Asia, where the incidence of gastric cancer is ten times higher than in Europe, surgery for gastric cancer is steadily evolving, especially regarding laparoscopic and robot-assisted procedures. This review first discusses the different options for reconstruction of the gastrointestinal passage after gastrectomy, ranging from Billroth procedures to the latest developments, such as the double tract reconstruction. In particular, the possibility of function-preserving partial gastrectomy, such as proximal and distal gastric resection and the corresponding reconstruction techniques are presented. The latest studies and technical developments are presented, especially with respect to laparoscopically assisted, completely laparoscopic and robot-assisted gastrectomies.

Bo Lian,* Jie Chen,* Zhengyan Li, Gang Ji, Shiqi Wang, Qingchuan Zhao, Mengbin Li Department of Digestive Surgery, National Clinical Research Center for Digestive Diseases, Xijing Hospital of Digestive Diseases, The Fourth Military Medical University, Xi’an, People’s Republic of China*These authors contributed equally to this workCorrespondence: Mengbin Li Email limbin@fmmu.edu.cnBackground: Laparoscopy has been increasingly used for the surgery of gastric cancer. However, the postoperative complications are still under-investigated and the short-term results of laparoscopic gastrectomy remain controversial. This study aimed to explore the differences of postoperative complications between laparoscopic and open radical gastrectomies in patients with gastric cancer through the large sample size, retrospective cohort study, and evaluate the safety of laparoscopy in patients who underwent radical gastrectomy.Patients and Methods: A total of 2,966 patients with gastric cancer (TNM I∼III) who underwent laparoscopy or open gastrectomy from February 2009 to March 2016 were enrolled in this study. Complications were categorized according to the Clavien–Dindo classification. The incidence and severity of complications between laparoscopic and open gastrectomy were compared using one-to-three propensity score matching (PSM) analysis. Logistic regression analyses were performed to identify risk factors related to postoperative complications.Results: A total of 2,966 patients were included in the study, including 687 (23.2%) in the LG (Laparoscopy gastrectomies) group and 2,279 (76.8%) in the OG (open gastrectomies) group. After PSM, a well-balanced cohort of 2,373 patients (676 cases in the LG group and 1,697 cases in the OG group) was further analyzed. The results showed that the incidence of overall complications in the LG group was significantly less than the OG group (15.4% vs 20.8%, P=0.003). However, the severe complications of the LG group showed no difference towards the OG group (5.8% vs 5.8%, P=0.952). Multivariate analysis revealed that laparoscopic surgery is a protective factor for the reduction of postoperative complications. Age ≥ 60 years, ASA classification IIIc and estimated blood loss ≥ 200 mL were confirmed as independent risk factors of overall complications.Conclusion: Compared with traditional open gastrectomy, LG is safe and feasible with less trauma and fewer complications for patients with gastric cancer.Keywords: gastric cancer, laparoscopy, gastric resection, postoperative complication, Clavien–Dindo classification

Background Laparoscopy has been increasingly used for the surgery of gastric cancer. However, the postoperative complications are still under-investigated and the short-term results of laparoscopic gastrectomy remain controversial. This study aimed to explore the differences of postoperative complications between laparoscopic and open radical gastrectomies in patients with gastric cancer through the large sample size, retrospective cohort study, and evaluate the safety of laparoscopy in patients who underwent radical gastrectomy. Patients and methods A total of 2,966 patients with gastric cancer (TNM I~III) who underwent laparoscopy or open gastrectomy from February 2009 to March 2016 were enrolled in this study. Complications were categorized according to the Clavien-Dindo classification. The incidence and severity of complications between laparoscopic and open gastrectomy were compared using one-to-three propensity score matching (PSM) analysis. Logistic regression analyses were performed to identify risk factors related to postoperative complications. Results A total of 2,966 patients were included in the study, including 687 (23.2%) in the LG (Laparoscopy gastrectomies) group and 2,279 (76.8%) in the OG (open gastrectomies) group. After PSM, a well-balanced cohort of 2,373 patients (676 cases in the LG group and 1,697 cases in the OG group) was further analyzed. The results showed that the incidence of overall complications in the LG group was significantly less than the OG group (15.4% vs 20.8%, P=0.003). However, the severe complications of the LG group showed no difference towards the OG group (5.8% vs 5.8%, P=0.952). Multivariate analysis revealed that laparoscopic surgery is a protective factor for the reduction of postoperative complications. Age ≥60 years, ASA classification IIIc and estimated blood loss ≥200 mL were confirmed as independent risk factors of overall complications. Conclusion Compared with traditional open gastrectomy, LG is safe and feasible with less trauma and fewer complications for patients with gastric cancer.

Gastric adenocarcinoma lymph node retrieval during gastrectomy and survival differ significantly between Asian and Western studies. It is unclear whether such disparities are the result of surgical technique, patient population, or other factors. In this observational study, we aimed to determine whether lymph node retrieval and outcomes differ between White, Black, and Asian American patients undergoing gastrectomy for adenocarcinoma.47,217 cases of gastric resection for gastric adenocarcinoma and its subtypes were identified in the National Cancer Data Base (2000-2015). Differences in demographics, lymph node retrieval, operative outcomes, and survival were compared by self-reported race (White, Black, and Asian).Asians had greater median lymph node retrieval (17) compared to White (15) and Black (16) patients, P 0.001. Lymph node ratio was lowest in Asian (0.03) compared to White (0.05) and Black (0.09) patients, P 0.001. Postoperative mortality was lowest in Asian patients on multivariable analysis (90-day mortality adjusted odds ratio of 0.54, P 0.001). Median survival was not yet reached for Asian patients but was 39.5 months for White and 43.0 months for Black patients (P 0.001). Differences in survival by race persisted on multivariable analysis (Asian adjusted hazard ratio was 0.64, 95% CI: 0.59-0.70, P 0.001).Asian-American patients with gastric cancer undergoing gastrectomy have greater lymph node retrieval, decreased lymph node ratio, decreased postoperative mortality, and increased long-term survival compared to White or Black Americans. Data suggest factors other than surgical technique and oncologic care may be responsible for gastric adenocarcinoma outcome differences seen between Asian and Western studies.

Professor Sergey Ivanovich Spasokukotskiy was born on June 10 (May 29 according to the old style) 1870 in Kostroma. In 1879 Sergey Spasokukotskiy began his study at the Yaroslav Provincial Gymnasium, after which he applied to the Faculty of Medicine of Moscow University in August 1888. After graduating from the Faculty of Medicine and receiving a diploma of doctor with honors in 1893, Sergey Ivanovich was left a supernumerary resident at the hospital surgical clinic. S. I. Spasokukotskiy is rightly considered one of the founders of surgical gastroenterology in Russia. In 1907 in St. Petersburg, he made a report «The breadth of indications for gastric resection in cancer and ulcer of it from the experience of 250 gastric operations and 29 resections». Problems of purulent surgery in the broadest sense have always been the focus of attention of Sergei Ivanovich, so there was a large purulent department in the clinic. In 1926, he was elected the Head of the Department and Clinic of Faculty Surgery of the II Moscow University. The works of Sergei Ivanovich and his students on hepatobiliary surgery, urology, neurosurgery were of great importance. Being since 1926 the head of the surgical sector of the Institute of Blood Transfusion, S. I. Spasokokotski has made a huge contribution to the development of domestic transfusiology. Under his guidance, the Faculty Surgery Clinic and the Blood Transfusion Institute Clinic developed blood transfusion indications for many pathological conditions. Spasokukotskiy had a high pedagogical skill, for which he earned great respect from students and young doctors, who always admired the Teacher ‘s personal example as a doctor, surgeon and scientist. Academician Sergei Spasokokotskiy died on November 17, 1943 and was buried in Moscow at the New Maiden Cemetery. For the best works in the field of surgery by the decision of the Government, there is a prize of his name.

Robotic-assisted gastrectomy is increasingly utilized for the treatment of gastric malignancies. However, the benefits of robotic surgery have been questioned. This study describes short-term outcomes in the establishment of a comprehensive robotic program for gastric malignancies.Patients who underwent robotic-assisted gastric resections between 2013 and 2018 were studied. Preoperative measures and surgical outcomes were analyzed. Finally we studied and analyzed robotic and open gastrectomy for the management of gastric adenocarcinoma (GC) at the same institution between 2000 and 2018 for quality benchmarking.Forty six patients (pts.) underwent robotic-assisted gastric resections. 26 (56.5%) were male, with a median age of 62 y (range: 29-87). Pathology included GC, gastrointestinal stromal tumors, neuroendocrine tumors, metastatic lesions, and benign processes. 19 pts. underwent total gastrectomy, 16 distal gastrectomy, four subtotal gastrectomy, and seven wedge resection. Pts. undergoing distal gastrectomy and wedge resection experienced shorter operative times and length of stay than total gastrectomy (P 0.01; P 0.01). Four operations (8.8%) were converted to open and 13 pts (28.3%) had postoperative complications, including an 8.7% readmission rate. Median lymph nodes retrieved during total, subtotal, and distal gastrectomy were 20 (13-46), 12.5 (0-26), and 16.5 (0-34), respectively. All pts. underwent margin negative resection. Median follow-up for GC was 21 mo, and 60% of pts. received adjuvant therapy at a median of 59d (range: 23-106).Robotic gastrectomy is a feasible alternative to open gastrectomy. Our results will help establish benchmarks to improve perioperative outcomes, especially length of stay and time to initiation of therapy.

Aim.To estimate the frequency of ulcerative bleeding, pyloric stenosis, need for pyloroplasty and the justification of vagotomy for perforated duodenal ulcer.Materials and Methods.We analyzed the surgical treatment of patients with perforated duodenal ulcer admitted to Podgorbunskiy Regional Clinical Emergency Hospital during 1999-2019.Results.In 2018, the number of surgical interventions due to perforated duodenal ulcer decreased by 56.4% in comparison with 1998. In 8.6% and 2.1% of patients, perforated duodenal ulcer was combined with pyloric stenosis and bleeding, respectively, requiring Judd pyloroplasty (diamond- shaped transverse excision) or gastroduodenotomy followed by Heineke-Mikulicz pyloroplasty (transversely closed longitudinal incision across the pylorus) and vagotomy. Distal gastric resection by Billroth’s operation II was required in 2.8% of patients. Repeated admission of patients with duodenal ulcer complications has been observed after isolated suturing of perforated duodenal ulcer.Conclusion.Over the last 20 years, the amount of surgical interventions because of perforated duodenal ulcer in Kemerovo Region decreased more than twofold. In > 10% patients, pyloric stenosis and bleeding require a gastric drainage. In > 8% patients, perforated duodenal ulcer is combined with pyloric stenosis; in these cases, Heineke-Mikulicz pyloroplasty may be a treatment of choice. In > 2% patients, perforated duodenal ulcer is combined with ulcerative bleeding requiring excision of the ulcer and optional distal gastric resection. Pyloroplasty may be combined with vagotomy to normalise the proteolytic activity of gastric acid.

A unified classification of operations for complicated gastroduodenal ulcers has been proposed to understand their place in the structure of surgical interventions, technological features and methods for their implementation, as well as functional efficacy and prevention of recurrent ulceration. This is a classification of operations in the pyloroduodenal zone with complicated duodenal ulcers, classification of vagotomy, classification of gastroenterostomy and classification of gastric resection. The proposed of operations classification for complicated gastroduodenal ulcers will help to a wide range of surgeons not only in understanding the range of surgical interventions, but also in an effort to master the techniques of operations for their application in surgical practice.

Der Stellenwert der simultanen Splenektomie im Rahmen einer onkologisch adaquaten Magenresektion wurde in den letzten Jahrzehnten haufig kontrovers diskutiert. Innerhalb einer prospektiven multizentrischen Beobachtungsstudie wurden vom 01.01.2007 bis zum 31.12.2009 in 141 Kliniken jeglichen Versorgungsprofils Daten von Patienten erfasst, die mit histologisch gesichertem, primarem Magenkarzinom oder Karzinom des osophagogastralen Ubergangs (AEG) stationar aufgenommen und einer operativen Therapie zugefuhrt wurden. Insgesamt wurden 2897 Patienten (Tumorresektionen n = 2545) in die Studie eingeschlossen. Die Rate der Splenektomie lag im gesamten Patientengut bei 11,1 % (n = 283), der prozentual hochste Anteil fand sich bei AEG-Tumoren mit 19,4 %. Sowohl im Gesamtkrankengut als auch in Abhangigkeit von der Tumorlokalisation zeigte sich in der Splenektomiegruppe eine hohere praoperative Begleitmorbiditat. Wahrend die Rate der allgemeinen postoperativen Komplikationen nach Splenektomie in der Gesamtgruppe und auch in Abhangigkeit von der Tumorlokalisation signifikant erhoht war, gab es hinsichtlich der spezifischen postoperativen Komplikationen keine Unterschiede. Eine signifikant hohere Hospitalletalitat nach Milzentfernung im Vergleich mit nichtsplenektomierten Patienten war nur in der Gruppe der AEG-Tumoren festzustellen (15,2 % vs. 5,0 %). Alle splenektomierten Patienten zeigten ein kurzeres Langzeituberleben (p

Merkel Cell Carcinoma (MCC) is a rare dermatologic malignancy with propensity for metastasis to lymph nodes, skin, lung, liver, bone, and brain. Metastasis to the stomach is rare with only 13 reported cases. We discuss the outcomes of a partial gastrectomy for the treatment of symptomatic MCC with gastric metastasis.

Background and study aims Endoscopic negative pressure therapy (ENPT) is used to close transmural defects in the rectum and esophagus. Very few reports have described ENPT to manage duodenal defects. This study was designed to demonstrate ENPT in a population of 11 patients with transmural duodenal leakages. Patients and methods The method of ENPT was adapted for duodenal use. Open-pore polyurethane-foam or a thin, open-pore double-layered film was wrapped around the distal end of a gastroduodenal tube. First, this open-pore element was placed on the inner wound in the duodenum with endoscopy. Second, continuous negative pressure of –125 mmHg was applied with an electronic pump. Drains were changed after 2 to 7 days. Results Eleven patients were treated with duodenal leaks. Eight defects occurred after operative closure of perforated duodenal ulcers, papillectomy or stricturoplasty, one anastomotic leakage after Billroth – 1 distal gastric resection, one iatrogenic perforation in endoscopic retrograde cholangiopancreatography, and one by a surgical drain. Median duration of therapy was 11 days (range 7 – 24 days). Complete healing of defects was achieved in all patients. Conclusion ENPT is an innovative endoscopic alternative for treatment of transmural duodenal defects.

SURGICAL APPROACH IN CONCOMITANT COMPLICATIONS OF DUODENAL ULCERNishanov F., Abdullajonov B., Nishanov M., Rustamov J., Ibragimov B., Mishenina E.Authors analyzed results of surgical treatment in 307 patients with concomitant complications of duodenal ulcer. Patients were divided into 2 groups according to the chosen diagnostic and therapeutic approach. The first group comprised 168 (54.7%) patients who underwent “traditional” gastric resection while the second group included 139 (45.3%) patients who underwent modifying variants of gastric resection.It was established that improvement of definite operation types and employment of optimal treatment methods can result in a decrease in frequency of early postoperative specific complication by 8.3% (from 15.5 to 7.2%, р

Background Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) are the most commonly performed bariatric procedures. RYGB involves altered gastrointestinal anatomy and 2 anastomoses, while SG involves gastric resection. When potential patients view images of the procedures, they may perceive RYGB to involve significant risk compared with SG, in which no significant gastrointestinal alterations are depicted. Objective To evaluate preferences for RYGB versus SG. Setting Survey of U.S. adults. Methods An electronic survey was distributed to 1000 U.S. adults. Respondents selected either RYGB or SG based on (1) procedural pictures alone, (2) only data on risks and benefits of each procedure, (3) pictures with corresponding risk/benefit profile, and (4) pictures with mismatched information. Results Overall, 999 individuals met inclusion criteria; 66 (7%) had undergone bariatric surgery and were excluded. Mean age and body mass index of respondents was 44.8 ± 14.6 years (n = 922) and 28.7 ± 8.0 kg/m2 (n = 915). A higher proportion of patients preferred RYGB to SG when images only were provided (54% versus 46%), when information only was provided (63% versus 37%), and when correct information with the procedure image was provided (57% versus 43%). When presented with mismatched information and images, 56% preferred RYGB information + SG image versus SG information + RYGB image (44%). Conclusions Based on this survey, providing evidence-based risks and benefits of a procedure resulted in the majority of respondents choosing RYGB over SG. When procedure images were provided alone, preference for RYGB and SG were similar. There are likely other factors contributing to increasing SG volume aside from patient preference.

Introduction: Seeds may be found in gastrointestinal tissue samples, and their multifaceted appearance may be challenging. The aim is to report a rough incidence of pathology samples which show seeds, specify the most frequent sample types and show an iconography of the most commonly identified seeds.Materials and Methods: Between 2017 and 2020, all gastrointestinal pathology cases in which seeds/seed parts were found, were collected and seed type described by referencing a seed image library.Results: Fifty cases with complete seeds/seed parts were collected: 16 colonic resections for colorectal cancer and diverticulosis, 13 appendiceal resections for appendicitis, 1 gastric resection. Fifteen cases were found in polypectomy specimens and 5 cases in colorectal endoscopic biopsies. Most frequent seed types were tomato, kiwi, blueberry, and blackberry seeds.Conclusion: Seeds may be found in up to 4% of specimens; their recognition may be useful to exclude parasitic infections as well as in forensic sciences.

Background: Most anastomotic leaks after surgical resection for esophageal or esophagogastric junction malignancies are treated endoscopically with esophageal stents. Internal drainage by double pigtail stents has been used for the endoscopic management of leaks following bariatric surgery, and recently introduced for anastomotic leaks after resections for malignancies. Our aim was to assess the overall efficacy of the endoscopic treatment for anastomotic leaks after esophageal or gastric resection for malignancies. Methods: We conducted a multicenter retrospective study in four digestive endoscopy tertiary referral centers in France. We included consecutive patients managed endoscopically for anastomotic leak following esophagectomy or gastrectomy for malignancies between January 2016 and December 2018. The primary outcome was the efficacy of the endoscopic management on leak closure. Results: Sixty-eight patients were included, among which 46 men and 22 women, with a mean ± SD age of 61 ± 11 years. Forty-four percent had an Ivor Lewis procedure, 16% a tri-incisional esophagectomy, and 40% a total gastrectomy. The median time between surgery and the diagnosis of leak was 9 (6–13) days. Endoscopic treatment was successful in 90% of the patients. The efficacy of internal drainage and esophageal stents was 95% and 77%, respectively ( p = 0.06). The mortality rate was 3%. The only predictive factor of successful endoscopic treatment was the initial use of internal drainage ( p = 0.002). Conclusion: Endoscopic management of early postoperative leak is successful in 90% of patients, preventing highly morbid surgical revisions. Internal endoscopic drainage should be considered as the first-line endoscopic treatment of anastomotic fistulas whenever technically feasible.

Background: Gastrointestinal stromal tumors (GISTs) are most frequently located in the stomach. In the setting of a multidisciplinary approach, surgery represents the best therapeutic option, consisting mainly in a wedge gastric resection. (1) Materials and methods: Between January 2010 to September 2020, 105 patients with a primary gastrointestinal stromal tumor (GISTs) located in the stomach, underwent surgery at three surgical units. (2) Results: A multi-institutional analysis of minimally invasive series including 81 cases (36 laparoscopic and 45 robotic) from 3 referral centers was performed. Males were 35 (43.2%), the average age was 66.64 years old. ASA score &gt, 3 was 6 (13.3%) in the RS and 4 (11.1%) in the LS and the average tumor size was 4.4 cm. Most of the procedures were wedge resections (N = 76, 93.8%) and the main operative time was 151 min in the RS and 97 min in the LS. Conversion was necessary in five cases (6.2%). (3) Conclusions: Minimal invasive approaches for gastric GISTs performed in selected patients and experienced centers are safe. A robotic approach represents a useful option, especially for GISTs that are more than 5 cm, even located in unfavorable places.

All bariatric procedures induce anatomical and physiological changes at different levels in the digestive system, according to their technical design. There are procedures where the modifications are milder and even reversible, such as Laparoscopic Adjustable Gastric Band. There are others where profound and irreversible alterations are expected in the anatomical configuration and in the physiological functioning because of extensive small bowel diversion along with gastric resection. Having a thorough knowledge of these changes is important for all professionals involved in the surgical treatment of patients suffering from morbid obesity. It helps to understand the presumed therapeutic outcomes, as well as to promptly identify and manage the possible adverse events that may result from these procedures. In this chapter, the main anatomical and physiological changes in the digestive system resulting from the most commonly performed bariatric procedures are addressed.

Resekce žaludku podle Billrotha I (B I) se provadi velice zřidka. Cilem teto retrospektivni studie je zhodnotit nase zkusenosti s diagnostickou a terapeutickou endoskopickou retrogradni cholangiopankreatikografii (ERCP) u pacientů po resekci žaludku podle Billrotha I. U pacientů se stavem po resekci žaludku podle B I trvalo studium souboru 20 let (listopad roku 1994 - prosinec roku 2014). V praci byli retrospektivně hodnoceni 3 pacienti po resekci žaludku podle B I, kteři měli projevy biliarni obstrukce. K provedeni ERCP byl ve vsech připadech použit standardni (tedy jako za normalni anatomicke situace) terapeutický videolateroskop Olympus. Kanylacniho uspěchu při diagnosticke ERCP bylo dosaženo u 3 pacientů ze 3 - tedy jednalo se o 100% uspěsnost diagnosticke ERC. U vsech těchto 3 pacientů byla při ERCP nalezena CDL. Dale pak u vsech těchto 3 pacientů s patologickým nalezem CDL na ERCP byla bezprostředně po diagnosticke ERCP realizovana endoskopicka lecba, jejimž uvodnim krokem byla vždy standardnim způsobem (tedy jako u normalni anatomie) provedena suficientni endoskopicka papilotomie (EPT). Nasledně byla provedena endoskopicka extrakce veskere CDL z hepatocholedochu do duodena. Celkem byla tedy terapeuticka ERCP kompletně uspěsna u vsech 3 pacientů ze 3 (100 % ze 3), u kterých byla původně endoskopicka lecba zahajena. V nasem souboru 3 pacientů se nevyskytly žadne komplikace. Při ERCP u pacientů po resekci žaludku podle B I jsme měli u vsech těchto nasich nemocných (3 pacienti s CDL) 100% uspěsnost diagnosticke i terapeuticke ERCP.

BACKGROUND: This propensity score matching (PSM) analysis assessed the influence of examined lymph nodes (ELNs) count on stage migration and survival in node-negative (pN0) gastric cancer (GC) patients. METHODS: We performed a retrospective analysis of 7,620 GC patients who underwent curative gastric resection in three Chinese medical centers. PSM was used to reduce the confounding effects between the pN0 GC patients with ELNs

Background and Objective: In surgical dissection, laparoscopic approach and open techniques do not differ significantly, but there is still no consensus on how anastomosis should be performed in both cardia and distal gastric tumors. Anastomosis can be performed by laparoscopy-assisted mini-laparotomy or by intracorporeal suture techniques. In this study, we aim to present our four years of clinical experience and short-term surgical results from 133 cases in order to evaluate the necessity of laparoscopic anastomosis. Methods: This study was approved by Ethics Committee (No: 1-8-19, date: 14/01/2019). Patients who underwent curative resection with the diagnosis of gastric adenocarcinoma between January 2014 and January 2018 in the Ankara University Surgical Oncology Department were included in the study. Results: Of the 133 patients included in the study, 108 (81.2) were male and the mean age was 60.51 ± 12.0 years. The time of anastomosis was significantly longer in patients undergoing intracorporeal anastomosis (p = 0.021). The incidence of anastomotic leakage was significantly higher in the group undergoing intracorporeal anastomosis (p = 0.004). Conclusions: We think that esophagojejunostomy and jejunojejunostomy anastomoses in patients undergoing total gastrectomy should be performed with intracorporeal techniques in terms of benefit risk assessment. We believe that it is more feasible to continue the case with mini laparotomy when anastomosis is reached in patients who are planned to have gastrojejunostomy. In addition, in terms of intracorporeal anastomoses and advanced laparoscopic techniques, intracorporeal anastomoses performed in gastric cancer surgery for a laparoscopist who has completed the learning curve do not appear to be very different in terms of anastomosis safety. doi: https://doi.org/10.12669/pjms.36.6.1915 How to cite this:Ogun E, Ekrem UA, Yuksel C, Serdar C, Basceken SI, Umit M, et al. Laparoscopic Gastric Resection for Gastric Cancer: Is Intracorporeal Anastomosis Necessary? Pak J Med Sci. 2020;36(6):1177-1182. doi: https://doi.org/10.12669/pjms.36.6.1915 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Two unusual cases of anastomotic ulcer complicated by bleeding after gastric resection are reported. There were retained antrum in one patient and long 'dry' intestinal loop after laparoscopic Roux resection in another one. Emergency gastric stump resection with Haberer procedure were successfully performed in both cases.Описаны 2 случая кровотечения из пептической язвы анастомоза после резекции желудка. В одном случае причиной осложнения явилась оставленная часть препилорического отдела, в другом — длинная «сухая» петля кишки после лапароскопической резекции по Ру. В обоих случаях в срочном порядке успешно выполнена резекция культи желудка с редуоденизацией по Haberer.

Highlights • Gastric perforation caused by intragastric balloon represents a rare but life-threatening complication. • There is a lack of information about perforation in the same day of surgery. • An endoscopic and laparoscopic approach with a gastric wedge resection was performed., Introduction IGB (Intragastric Balloon) is acknowledged to be a safe and secure device, whose outcomes in terms of weight loss are widely discussed. Bariatric community has soon noted tolerance and benefit of this tool, considered a first and easy step before bariatric surgery. Nevertheless, some authors have described a series of complications that, although rare, could be life threatening and hard to manage, as a gastric perforation. Presentation of case We reported a case of a 55-year-old obese woman, undergone placement of IGB device heisting in a gastric perforation. In the same day of surgery, we performed an emergency, applying a combined endoscopic and laparoscopic approach, to remove the balloon and to close perforation by a gastric resection. Discussion. Short term outcome was satisfactory, and the patient had a successful further follow up and weight loss. Conclusion IGB is a valuable tool among bariatric procedure, nevertheless the surgeon has to consider the possible and life-threatening complications and to provide a multidisciplinary equip to face this occurrence.

WOS:000503809200010 Objective - HER-2/neu assay in gastric cancers is routinely evaluated by immunohistochemistry and fluorescent in situ hybridization methods because the monoclonal antibody trastuzumab developed against HER-2/neu give rise to significant improving on the survival. In the HER-2/neu evaluation, some problems related to the sampling process, analysis method, tumor biology and heterogeinity are encountered. Our aim in the present study was to analyze these evaluation problems on endoscopic biopsy samples and resection materials of our cases with gastric carcinoma. Material and Methods - The study included 109 gastric cancer cases. The analyses were realized on the resection materials of the 109 cases and the endoscopic mucosa biopsies of 43 out of these 109 cases. Immunohistochemistry was applied on mucosa biopsies and, tumor sections of resections, while fluorescent in situ hybridization was performed on tumor sections of resections (21 cases). The assays results were compared with each other and clinicopathological parameters. Results - Our rate of HER-2/neu positivity (IHC3+ and IHC2+/FISH+ cases) was 6.42%. The compatibility rate between the rates of overexpression and amplification in resections was 90.5% while the compatibility ratio between the overexpression rates of mucosa samples and resections was 95.4%. The false negativity rate on mucosa biopsies was detected as 4.65%. HER-2/neu status was not correlated with unfavorable clinicopatological features. Conclusion - Our gene positivity rate was near the lower limit of the range reported in the literature. Our compatibility rate between the results of immunohistochemistry and fluorescent in situ hybridization was over 90%. However our false negativity rate in mucosa biopsy analysis was low according to the literature. In order to preclude false negativity arising from tumor heterogeinity, we think that immunohistochemistry should be applied on the whole section.

Case series Patient: Male, 67 • Female, 60 Final Diagnosis: Gastric ulcer • early gastric cancer Symptoms: Upper gastrointestinal bleeding • atypical epigastric pain Medication: — Clinical Procedure: Endoscopically assisted laparoscopic wedge gastric resection Specialty: Surgery Objective: Educational purpose Background: The first gastric resection for stomach cancer was performed in 1879, and the first gastric resection for gastric ulcer disease was performed in 1882. During the 1990s, the first laparoscopic gastrostomies were reported. During the past decade, laparoscopic techniques have developed rapidly, gaining wide clinical acceptance. Minimally invasive surgery is now shifting the balance away from traditional open methods. We report 2 cases of endoscopically assisted laparoscopic local gastric resections for both gastric cancer and gastric ulcer disease. Case Report: The first case involves a 67-year-old male patient who suffered from recurrent bleeding from a gastric ulcer located 4–5 cm from the gastroesophageal junction. The patient was subjected to endoscopically assisted laparoscopic wedge resection of the affected part of the stomach, had an uneventful recovery and was discharged on the third postoperative day. The second case involves a 60-year-old female patient who was diagnosed with intramucosal gastric adenocarcinoma and was also subjected to endoscopically assisted laparoscopic wedge gastrectomy. This patient also had an uneventful recovery and was discharged on the second postoperative day. Conclusions: Endoscopically assisted laparoscopic local gastric resection is a minimally invasive procedure which allows the surgeon to operate under direct visualization of the internal part of the stomach. Thus, it enables the surgeon to safely remove the affected part within healthy margins, providing the patient with all the advantages of laparoscopic surgery.

The surgical intervention implying total ablation of tumor, continues to be the only method giving hope for recovery of patient despite a significant number of combined and complex methods of treatment of the given disease. However, many positions of the given conception underwent cardinal changes. Nowadays, most of authors recommend after gastric resection to restore to the extent possible natural anatomic relationships that provides best functional results. At the same time, certain researchers give preference to Billroth-II mode and at that some of them are devoted opponents of gastric resection by Billroth-I mode in case of cancer. This opinion is based on supposition that gastric resection by Billroth-II mode provides in greater extent radicalism in case of treatment of malignant neoplasms of given localization. The main factor restraining application of this most physiological operation is established opinion alleging its oncologic non-efficacy. The thesis is substantiated that intervention into modification of operation according Billroth method does not result in increasing of number of post-operative complications and that there is no differences also in distant results of surgical treatment of gastric cancer in case of application of both modes of restoration of continuity of digestive tract after sub-total distal resection. At the same time, quality of life of patients becomes better after reconstruction of digestive tract using gastroduodenal anastomosis. Most of researchers, studying indications to sub-total gastric resection using method Billroth-I, assume that it is reasonable to apply this particular mode of restoration of continuity of gastrointestinal tract only in case of early cancer, its exophytic forms (stage I and II) located in area of stomach angle or its low one third of its body and absence of metastases into regional lymphatic nodes.

Introduction Situs inversus totalis (SIT) is a very rare condition that is seen at a rate of one in about 6000-8000 births. Aim To offer a general view on the coexistence of SIT and gastric cancer, accompanied by a literature review. Material and methods Within the scope of this study, the case of a patient with gastric adenocarcinoma and SIT has been presented. Previous research on gastric cancer cases with SIT was reviewed through a comprehensive search of the PubMed, Medline, and Google Scholar databases. The keywords used to conduct this research were "situs inversus totalis and gastric cancer," "situs inversus totalis and gastric malignant," and "situs inversus totalis and gastric resection." The database search covered English studies published between 2000 and 2016. Results The results of our literature review revealed 20 studies of patients with gastric cancer and SIT, and 21 related cases. Overall, 12 of the patients were male, 9 were female, and their mean age was 61.8 ±10.97 years. The vascular assessment data showed that three out of the 13 mentioned cases had vascular anomalies. Eleven of the patients had laparoscopic resections, and one of the patients that had a surgical procedure exhibiting a postoperative mechanical obstruction. Conclusions The coexistence of SIT and gastric cancer is a very rare condition, and a careful preoperative radiological assessment should be conducted because there can be accompanying vascular anomalies. Laparoscopies and robotic surgeries can be performed for suitable patients at experienced centres, consistent with oncological principles.

Exocrine pancreatic insufficiency (EPI) is one of the possible mechanisms of fat maldigestion following gastric surgery, together with reduced food intake, loss of gastric reservoir, small bowel bacterial overgrowth and rapid small bowel transit. Oral pancreatic enzyme replacement therapy (PERT) is the mainstay of treatment for EPI. The efficacy and safety of pancreatic enzyme substitution in patients following gastric resection remains unclear. This review article summarizes relevant studies addressing PERT after gastric resection.

Aim. Evaluation of different methods of surgical treatment of patients with gastroduodenal ulcer, complicated by a combination of perforation and hemorrhage and the rationale for choosing optimal method of surgical treatment. Materials and methods. The article summarizes the experience of surgical treatment of combined complications of ulcer disease in the form of perforation and hemorrhage. This combination was found in 52 from 753 patients who underwent surgery for ulcer perforation. The hemorrhage arose from a perforated ulcer, and other. The hemorrhage was in the abdomen (5 cases or 0,66%) and in the lumen of the gastrointestinal tract (47 patients or 6,2%). Results. In the surgical treatment of combined complications of gastroduodenal ulcer disease the mortality rate was more than 19%. The most severe patients were those who had free perforated ulcer combined with hemorrhage. Gastric resection was applied at 31,9%. Simple stitching perforated hole ulcers is unacceptable because 2/3 patients with gastroduodenal ulcers have at least two ulcers, one of which is complicated by perforation and hemorrhage. Even at the minimum volume of surgical intervention it is appropriate to perform pyloroplasty according to Judd. Conclusion. The surgery of choice is pyloroplasty according to Judd. Approximately 1/3 of patients have to resort to resection of the stomach, which is dictated by the pathological changes in pyloroduodenal area.

Background Gastric cancer remains a formidable treatment challenge. For decades, treatment consisted mostly of surgical intervention for this deadly disease. With improvements in the multi-disciplinary management of solid organ malignancies, the approach to this disease is being stepwise refined. Main body One of the prevalent controversies in the surgical management of gastric cancer rests on the need for adequate harvesting of lymph nodes. For decades, lymph node dissection is regarded as a staging technique useful in only upstaging the disease. The adoption of D2 lymphadenectomy has been particularly slow to mature. But with prevailing data from Asia consistently demonstrating a survival benefit from lymphadenectomy, it calls into question the notion of lymphadenectomy as being solely a staging procedure. Conclusions As gastric resection techniques are being better defined in western countries and surgical morbidities lowered on its execution, D2 lymphadenectomy is becoming more accepted as the new standard in the management of gastric cancer.

Introduction . The lack of low-cost and available methods for the diagnosis of lymph node metastasis from gastric cancer and the standards of surgery for proximal gastric cancer is a hot topic for research. the aim of research is to study the effectiveness of the method of pigment lymphography and to develop criteria for determining the extent of surgery in the treatment of locally advanced proximal gastric cancer. Material And Methods . The study included 68 patients with locally advanced proximal gastric cancer. All patients were divided into 2 groups according to the extent of surgery: proximal subtotal gastric resection and gastrectomy. For intraoperative detection of lymph node metastases, the method of peroral pigmented lymphography was used. Results . The sensitivity, specificity and accuracy of pigment lymphography in detecting lymph node metastases were 99.0 %, 89.8 % and 93.4 %, respectively. The developed algorithm for the choice of the extent of surgery for proximal gastric cancer demonstrated advantage of proximal subtotal resection over gastrectomy in terms of overall survival (66.4 ± 13.2 % versus 48.7 ± 16.9 %, p=0.021). Conclusion . Peroral pigmented lymphography was shown to be an effective method in detecting lymph node metastases from gastric cancer. Proximal subtotal gastrectomy in patients with locally advanced gastric cancer improved long-term treatment outcomes.

Highlights • The article represents giant gastric lipoma with serious GI bleeding. A rare finding of a rare disease that carries significant morbidity and mortality. • To review the literature and to highlight the awareness of this disease and familiarity of its typical radiological findings for reaching proper diagnosis especially in acute setting. • TO emphasize that stomach preserving surgery is an optimal surgical option (enucleation is better than resection)., Introduction Gastric lipomas are unusual benign lesions and account for less than 1% of all tumours of the stomach and 5% of all gastrointestinal lipomas (Thompson et al.2003; Fernandez et al. 1983 [1], [2]). Although predominantly asymptomatic and indolent; they may present with gastric outlet obstruction and upper gastrointestinal (GI) bleeding owing to size and ulceration. Only a few cases have been reported, presenting large in size with massive GI bleeding (Alcalde Escribano et al. 1989; Johnson et al. 1981 [3], [4]). Presentation of case We report the case of a 62-year-old gentleman who presented to the emergency department with massive upper GI hemorrhage. He was initially resuscitated and stabilized. Later gastroscopy showed a large submucosal tumour (Fig. 1). Biopsy revealed adipose tissue. Computed tomography (CT) scan of the abdomen and pelvis showed a huge well defined oval soft tissue lesion measuring about 16 × 8 × 8 cm. The mass noted a homogenous fat density arising from the posterior wall of stomach with no extramural infiltration (Fig. 2). The tumour was completely enucleated through an explorative gastrotomy incision (Fig. 4). Discussion and conclusion Massive bleeding secondary to a giant gastric lipoma is a rare finding of a rare disease. The majority of cases in the literature result in major gastric resection. Familiarity with its radiological findings and a high index of suspicion can lead to proper diagnosis in the acute setting. If malignancy is carefully ruled out, stomach preserving surgery is an optimal treatment option.