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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.

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.

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.

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.

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

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 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.

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.

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 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.

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.

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.

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.

Gastric cancer is one of the most common cancers worldwide, and radical gastrectomy is an integral component of curative therapy. With improvements in perioperative morbidity and mortality, attention has turned to short- and long-term post-gastrectomy quality of life. This article reviews the common psychometric surveys and preference-based measures used among patients following gastrectomy. It also provides an overview of studies that address associations between surgical decision-making and postoperative health-related quality of life. Further attention is focused on reported associations between technical aspects of the operation, such as extent of gastric resection, minimally-invasive approach, pouch-based conduits, enteric reconstruction, and postoperative quality of life. While there are several randomized studies that include quality of life outcomes, much remains to be explored. The relationship between symptom profiles and preference-based measures of health state utility is an area in need of further research.

Background Neuroendocrine tumors (NETs) are relatively rare neoplasms with the increasing survival due to the development of early diagnostics. There is no universal position in treatment and follow up of small (~20 mm) gastric NETs. Clinical cases Two female patients 51 and 66 y.o. with multiple gastric NETs

The surgical treatment of peptic ulcer disease (PUD) has declined significantly in recent decades due to the advent of H. pylori treatment, acid-suppressing medications, and endoscopic therapies. Uncomplicated PUD can often be treated successfully with medical interventions. However, surgical management of ulcer disease still plays a role in refractory and complicated ulcer disease. The first large gastric resection with reconstruction was described by Theodor Billroth in 1885. In the following years, Dr. Billroth and colleagues conceived a number of surgical techniques for reconstruction following gastric resection. Among the most widely adopted and still used in practice today is the Billroth I gastroduodenostomy (B-I). The B-I procedure is a hemigastrectomy with gastroduodenostomy that restores the native configuration of the gastrointestinal tract. In this chapter we will discuss the indications, technique, management, complications, and expected outcomes of B-I reconstruction for PUD.

Introduction Delayed gastric emptying (DGE) is frequent after pancreaticoduodenectomy (PD). Several RCTs have explored operative strategies to minimize DGE, however, the optimal combination of gastric resection approach, anastomotic route, configuration and the use of enteroenterostomy remains unclear. Methods MEDLINE, Embase and CENTRAL databases were systematically searched for RCTs comparing gastric resection (classic Whipple, pylorus-resecting, pylorus-preserving), anastomotic route (antecolic, retrocolic), configuration (loop gastroenterostomy/Billroth II, Roux-en-Y), and use of enteroenterostomy (Braun). A random-effects, Bayesian network meta-analysis with non-informative priors was conducted to determine the optimal combination of approaches to PD for minimizing DGE. Results Twenty-four RCTs, including 2526 patients and 14 approaches were included. There was some heterogeneity, although inconsistency was low. The overall incidence of DGE was 25.6 per cent (647 patients). Pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy was associated with the lowest rates of DGE and ranked the best in 35 per cent of comparisons. Classic Whipple, retrocolic, Billroth II with Braun ranked the worst for DGE in 32 per cent of comparisons. Pairwise meta-analysis of retrocolic versus antecolic route for gastrojejunostomy found increased risk of DGE with the retrocolic route (odds ratio 2.10, 95 per cent credibility interval (cr.i.) 0.92 to 4.70). Pairwise meta-analysis of enteroenterostomy found a trend towards lower DGE rates when this was used (odds ratio 1.90, 95 per cent cr.i. 0.92 to 3.90). Having a Braun enteroenterostomy ranked the best in 96 per cent of comparisons. Conclusion Based on existing RCT evidence, a pylorus-resecting, antecolic, Billroth II with Braun enteroenterostomy seems to be associated with the lowest rates of DGE. Preregistration PROSPERO submitted 23 December 2020. CRD42021227637, Bayesian network meta-analysis with non-informative priors was conducted to determine the optimal combination of approaches to pancreaticoduodenectomy for minimising delayed gastric emptying (DGE). Based on existing RCT evidence, a pylorus resecting, antecolic, Billroth II anastomosis with Braun enteroenterostomy is associated with the lowest rates of DGE after pancreatoduodenectomy.

Prof. Halpern (New. Khir. Arch., No. 32), giving 44 pages. peptic ulcers of the small intestine, obtained after gastric resection according to the Billroth II method and published by various authors over the past 3 years, considers such a number of complications to be alarmingly high.

Background Post-operative C-reactive protein (CRP) has been investigated as a predictor of anastomotic leak (AL) following colorectal surgery, but its role in oesophago-gastric surgery is not yet established. Methods Clinical data and post-operative CRP values of patients who underwent elective oesophago-gastric resection between January 2004 and July 2014 were analysed retrospectively. Only patients with an oesophageal anastomosis were included. AL was defined as leakage of contrast material seen on imaging or a leak confirmed intraoperatively on return to theatre. Results One hundred and forty-five patients were identified. Of the 145 patients, 13 (9%) developed AL. The CRP on post-operative days (POD) 2, 3 and 6 had the greatest diagnostic accuracy, with an area under the curve of 0.82, 0.80 and 0.91 respectively. Using a cut-off value of 209 mg/L on POD 2, the sensitivity was 100%, the specificity was 61%, the positive predictive value (PPV) was 21% and the negative predictive value (NPV) was 100%. Using a cut-off value of 190 mg/L on POD 3, the sensitivity was 100%, the specificity was 59%, the PPV was 21% and the NPV was 100%. Using a cut-off value of 154 mg/L on POD 6, the sensitivity was 100%, the specificity was 78%, the PPV was 29% and the NPV was 100%. Conclusion Post-operative CRP is an accurate negative predictive test for the development of AL following oesophago-gastric surgery. It may help to discriminate between patients with a high risk of leak and those in which AL is unlikely to occur.

Morbidity after gastrectomy remains high. The potentially modifiable risk factors have not been well described. This study considers a series of potentially modifiable patient-specific and perioperative characteristics that could be considered to reduce morbidity and mortality after gastrectomy.This retrospective cohort study includes adults in the ACS NSQIP PUF dataset who underwent gastrectomy between 2011 and 2013. Sequential multivariable models were used to estimate effects of clinical covariates on study outcomes including morbidity, mortality, readmission, and reoperation.Three thousand six hundred and seventy-eight patients underwent gastrectomy. A majority of patients had distal gastrectomy (N = 2,799, 76.1 %) and had resection for malignancy (N = 2,316, 63.0 %). Seven hundred and ninety-eight patients (21.7 %) experienced a major complication. Reoperation was required in 290 patients (7.9 %). Thirty-day mortality was 5.2 %. Age (OR = 1.01, 95 % CI = 1.01-1.02, p = 0.001), preoperative malnutrition (OR = 1.65, 95 % CI = 1.35-2.02, p 0.001), total gastrectomy (OR = 1.63, 95 % CI = 1.31-2.03, p 0.001), benign indication for resection (OR = 1.60, 95 % CI = 1.29-1.97, p 0.001), blood transfusion (OR = 2.57, 95 % CI = 2.10-3.13, p 0.001), and intraoperative placement of a feeding tubes (OR = 1.28, 95 % CI = 1.00-1.62, p = 0.047) were independently associated with increased risk of morbidity. Association between tobacco use and morbidity was statistically marginal (OR = 1.23, 95 % CI = 0.99-1.53, p = 0.064). All-cause postoperative morbidity had significant associations with reoperation, readmission, and mortality (all p 0.001).Mitigation of perioperative risk factors including smoking and malnutrition as well as identified operative considerations may improve outcomes after gastrectomy. Postoperative morbidity has the strongest association with other measures of poor outcome: reoperation, readmission, and mortality.

Introduction Malignant gastrointestinal stromal tumours are known for their diagnostic elusiveness and they demonstrate wide variability in their malignancy. We report a case of a large malignant GIST of the stomach involving the spleen and diaphragm.

Complete surgical resection with negative margins without lymphadenectomy is the treatment of choice for nonmetastatic Gastrointestinal Stromal Tumors (GISTs). Laparoscopic resection of gastric GISTs5 cm is an acceptable and oncologically feasible, safe, and effective treatment. We present our experience of an endoscopically assisted minimally invasive transumbilical single-incision laparoscopic (SILS) technique for gastric GISTs resection.Four patients with small gastric GISTs ≤5 cm located on the greater curvature or the anterior wall were resected with SILS by using a lesion-lifting technique under the guidance of flexible gastroscopy.The technique was feasible and safe and offered significant advantages in locating the tumor and controlling the resection margins. There were no major intraoperative or postoperative complications, conversions, or tumor ruptures. Pathology showed low-risk GISTs resected with disease-free margins without tumor rupture. No recurrences have been observed.The endoscopically assisted SILS wedge gastrectomy is a feasible, safe, and advantageous technique for the treatment of the greater curvature or anterior wall gastric GISTs.

Background: Laparoscopic sleeve gastrectomy (LSG) is currently the most frequently performed bariatric procedure in Turkey. The goal of weight reduction surgery is not only to decrease excess weight, but also to improve obesity related comorbidities and quality of life (QoL). Aim: To evaluate the impact of LSG on patient quality of life, weight loss, and comorbidities associated with morbid obesity according to the updated BAROS criteria. Methods: Eleven hundred thirty-eight adult patients were undergone to LSG by our bariatric surgery team between January 2013 and January 2016. A questionnaire (The Bariatric Analysis and Reporting Outcome System - BAROS) was published on social media. The data on postoperative complications were collected from hospital database. Results: Number of respondants was 562 (49.4%). Six of 1138 patients(0.5%) had leakage. All patients who had leakage were respondants. The overall complication rate was 7.7%. After a mean period of 7.4±5.3 months(1-30), mean excess weight loss was 71.3±27.1% (10.2-155.4). The respondants reported 772 comorbidities. Of these, 162 (30%) were improved, and 420 (54.4%) were resolved. The mean scores for QoL were significantly increased after LSG (range, p

Introduction Enhanced recovery after surgery programs in abdominal surgery are being established progressively. The aim of this study is to evaluate the application of different perioperative care measures in gastric surgery by Spanish surgeons. Methods A descriptive study of 162 surveys answered from September to December 2017 about the management and perioperative care in non-bariatric gastric resection surgery. Results Antibiotic and antithrombotic prophylaxis are always used by 96.9 and 99.4%, respectively; 62.7% recommend a fasting time for liquids >6 h and only 3% use preoperative carbohydrate drinks. Only 32.4 and 13.3% of subtotal and total gastrectomies are performed laparoscopically, respectively; 56.8% use epidural analgesia, and drains are always placed by 53.8% in total gastrectomy. Nasogastric tubes are used selectively by 34.6% and always by 11.3%. Bladder catheters are removed during the first 48 h by 77.2%. In the first 24 postoperative hours, less than 20% indicate oral intake and 15.4% mobilize their patients; 49.3% indicate walking after the first 24 h; 30.4% apply a clinical pathway for the care of these patients and only 15.2% used an enhanced recovery after surgery protocol. Conclusions The implementation of enhanced recovery after surgery measures in non-bariatric gastric resection surgery is not widespread in our country.

The increasing subspecialisation of general surgeons in their elective work may result in problems for the provision of expert care for emergency cases. There is very little evidence of the impact of subspecialism on outcomes following emergency major upper gastrointestinal surgery. This prospective study investigated whether elective subspecialism of general surgeon is associated with a difference in outcome following major emergency gastric surgery.Between February 1994 and June 2010, the data from all emergency major gastric procedures (defined as patients who underwent laparotomy within 12 hours of referral to the surgical service for bleeding gastroduodenal ulcer and/or undergoing major gastric resection) was prospectively recorded. The sub-specialty interest of operating surgeon was noted and related to post-operative outcomes.Over the study period, a total of 63 major gastric procedures were performed of which 23 (37%) were performed by specialist upper gastrointestinal (UGI) consultants. Surgery performed by a specialist UGI surgeon was associated with a significantly lower surgical complication (4% vs. 28% of cases; p=0.04) and in-patient mortality rate (22% vs. 50%; p=0.03).Major emergency gastric surgery has significantly better clinical outcomes when performed by a specialist UGI surgeon. These results have important implications for provision of an emergency general surgical service.

Robotic gastrectomy was first described in 2003 for gastric cancer. Since then, robotic-assisted resection has demonstrated advantages for early gastric cancer with respect to decreased blood loss and potentially greater number of retrieved lymph nodes. Technical benefits of robotics include enhanced visualization and greater range of instrument movement; due to this, the robotic technology has been used for gastric resection for benign disease such as peptic ulcer disease as well. This chapter will aim to discuss the indications for the application of robotic-assisted gastrectomy in both malignant and benign disease; the technical aspects in the use of robotics in these surgeries; the potential advantages of the use of the robot in these cases; and future directions.

Perforated gastric ulcer is one of the most life‑threatening complications of peptic ulcer disease with high morbidity and mortality rates. The surgical strategy for gastric perforation in contrast with duodenal perforations often requires consilium and intraoperative debates. The subject of the debate is a 59‑year‑old male patient who presented with perforated giant gastric ulcer complicated by generalized peritonitis and severe sepsis. The debate is based on a systematized table dividing all factors into three groups and putting them on surgical scales. Pathology‑related factors influencing the decision‑making are size and site of perforation, local tissue inflammation, signs of malignancy, simultaneous complications of peptic ulcer, peritonitis, and sepsis. Besides these factors, patient‑ and healthcare‑related factors should also be considered.Keywords: Gastrectomy, gastric resection, gastric ulcer, giant ulcer, perforated ulcer, primary ulcer repair

Minimally invasive gastric resections carry several advantages, including less intraoperative blood loss, faster recovery time, reduced pain, and decreased hospital length of stay and quicker return to work. Numerous trials have proved that laparoscopic and robotic-assisted gastrectomy provides equivalent surgical and oncologic outcomes to open approaches. As with any minimally invasive approach, advanced minimally invasive training and good judgment by a surgeon are paramount in selecting patients in whom a minimally invasive approach is feasible. With increasing research in patient populations with more advanced disease, the indications are likely to continue to expand.

Robot-assisted laparoscopic vs open gastrectomy for gastric cancer: Systematic review and meta-analysis

Laparoscopic gastric resection cannot be easily applied for submucosal tumors near the esophagogastric junction (NEJ-SMTs). Furthermore, there have been no reports of single-incision laparoscopic surgery (SILS) for NEJ-SMTs. We evaluated our laparoscopic surgical outcomes for NEJ-SMTs, including a newly introduced phase of SILS. We retrospectively reviewed a total of 18 patients diagnosed with NEJ-SMTs who underwent laparoscopic surgery between April 2002 and September 2013. All patients underwent laparoscopic gastric resection without local complications and with a negative surgical margin, including 12 patients treated with conventional laparoscopic surgery (CLS) and six patients treated with SILS. The mean length of the operation was 184.3 ± 52.3 min, and the mean blood loss was 19.2 ± 17.7 mL. All patients underwent complete resection. There were no statistically significant differences between the CLS and SILS groups in terms of the surgical outcomes. Despite this challenging location of the tumor, laparoscopic gastric resection for NEJ-SMTs is safe and feasible. Furthermore, SILS can provide a better cosmetic result, which can lead to better global patient satisfaction in carefully selected patients with NEJ-SMTs.

Although the prognosis of early gastric cancer (EGC) is considered to be satisfactory, some patients experience tumor relapse after curative surgery. Both pathogenesis and risk factors of recurrence remain unclear. We describe a case report of a 49-year-old male who underwent subtotal gastric resection D2A for angular gastric cancer. Histological examination revealed gastric adenocarcinoma with low grade of differentiation and colloid areas, intramucosal, and absence of neoplastic proliferation in the surgical margins, in omental stroma and in the six examined lymph nodes (pT1, pN0). 11 years later, the same patient underwent D2 total gastrectomy for gastric cancer in the remnant stomach. New histological examination revealed again gastric adenocarcinoma, intramucosal, medium degree of differentiation, no documentable neoplastic proliferation within the limits of surgical resection, in the thirty-three examined lymph nodes and in the omentum (pT1, pN0).

Minimally invasive gastrectomy has become the standard of care in many centers in Asia but remains unpopular in Europe. The aim of this article is to present the technique of laparoscopic robot-assisted total gastrectomy. The presented case involved a 66-year-old female patient with an advanced gastric cancer on the lesser curvature of the stomach. The laparoscopic part of the procedure involved opening the lesser sac, mobilization of the greater curvature and transection of the duodenum. A robot was used for the D2 lymphadenectomy and creation of the anastomosis. In summary, we have found that during a total gastrectomy for advanced gastric cancer a successful oncological resection can be achieved using a minimally invasive approach. We have also found that by combining conventional laparoscopy with robotic assistance we could overcome the technical difficulties with regards to lymph node dissection and anastomosis.

Although natural orifice specimen extraction is now relatively widely performed, there have been no reports on gastric resection with specimen extraction through the transgastric route for peptic ulcer disease. A hybrid technique of the laparoscopic and endoscopic approach is presented in the case of a 58-year old male patient. Preoperative gastric fibroscopy showed postulcer pyloric and antral stenosis. Laparoscopic exploration confirmed gastric enlargement. Laparoscopic two-thirds gastrectomy was performed. The staple line suture of the residual stomach was excised and the specimen was extracted through the esophagus and mouth with a gastroscope. Finally, the residual stomach was closed again using linear endostaplers. Reconstruction was performed according to the Roux-en-Y method. Gastric resection using natural orifice specimen extraction (NOSE) may be a feasible operative procedure. The NOSE with the combination of standard laparoscopy and specimen extraction through a natural orifice can be considered as a bridge to natural orifice translumenal endoscopic surgery.

The prognostic significance of the number of retrieved lymph nodes (RLNs) in gastric cancer remains controversial. Therefore, we designed a multicenter collaborative database to investigate the correlation between the number of RLNs and prognosis of patients with advanced gastric cancer after curative resection.We retrospectively analyzed 1103 patients who underwent gastrectomy for stage II/III gastric cancer between 2010 and 2014. Lymph nodes, which were retrieved by surgeons from surgically resected specimens, were validated by pathologists. A target population and the optimal cutoff were determined using receiver operating characteristic (ROC) curve analysis. After propensity score matching of eight variables, including splenectomy and adjuvant chemotherapy, the prognostic significance of RLNs was evaluated.According to ROC curve analysis, the optimum cutoff score for predicting postoperative survival was 40. After matching, the backgrounds of patients in the RLN 40 and RLN ≥ 40 groups (n = 87 each) became well-balanced. The RLN 40 group experienced significantly shorter relapse-free and overall survival. The prevalence of peritoneal recurrence was significantly increased in the RLN 40 group. RLN 40 was an independent prognostic factor in multivariable analysis, although pathological N status was not. A forest plot revealed that the RLN 40 group was at greater risk of recurrence in most subgroups.RLN 40 was associated with an adverse prognosis of patients with stage III gastric cancer who underwent total gastrectomy.

166 Background: Prognosis remains poor for metastatic gastric cancer. Gastrectomy in the setting of stage IV disease is typically reserved for palliation of symptoms such as bleeding or obstruction. The potential survival benefit of resection on survival is controversial. The objective of this study is to determine using the National Cancer Database (NCDB) whether there was an increase in overall survival in patients diagnosed with metastatic cancer who underwent a gastrectomy in addition to chemotherapy. Methods: The NCDB was queried between 2004-2014 for patients with metastatic gastric cancer (adenocarcinoma, mucinous adenocarcinoma, or signet ring carcinoma) who received chemotherapy. Kaplan-Meier analysis and multivariate Cox proportional hazards regression analysis was done using SAS software. Results: A total of 20,599 patients met inclusion criteria. A minority of these patients (2,508; 12.2%) underwent gastric resection in addition to chemotherapy. The median overall survival for those who underwent gastrectomy was 14.1 months compared to 8.6 months for chemotherapy alone (p < 0.0001). Other factors influencing survival included age, race, Charlson-Deyo co-morbidity index, year of diagnosis, primary tumor site, grade, and metastasis to multiple organs. Following multivariate analysis, patients who underwent gastrectomy and chemotherapy had a 36% lower risk of death compared to patients that had received chemotherapy alone (HR 0.64, 95% CI 0.48–0.80, P < 0.0001). Conclusions: In this population analysis, the addition of gastrectomy to chemotherapy was associated with improved overall survival for patients with stage IV gastric cancer and should be considered for patients that are surgical candidates. Patients who underwent gastrectomy had a 36% decreased risk of death compared to those who had chemotherapy alone. However, only a small proportion of patients in the United States received multimodality treatment.

Background The stomach is the most common site for gastrointestinal stromal tumors (GIST) development. Surgical treatment consists of excision of the entire neoplastic mass, with sufficient surgical margins within healthy tissue. This can be achieved with different techniques ranging from wedge resections, typical gastric resections, right up to total gastrectomy. There aren't clear guidelines for the use of minimally invasive approach. Materials and methods From January 2011 to April 2012, 5 patients with presumed preoperative diagnosis of GIST were treated by robotic surgery at the Unit of Surgery and Advanced Oncologic Therapies, Forli Hospital, Forli, Italy. We report operative techniques, perioperative outcomes and follow-up. Results Lesions were localized at anterior wall of gastric antrum ( N = 2) and near pyloric area ( N = 3). Mean tumor size was 5 cm (range 4–7 cm). Surgical procedures were 5 distal gastrectomy. None intervention was converted to open surgery and there weren't major intraoperative complications. Median operative time was 240 min (range 210–300 min) and mean intraoperative blood loss was 96 ml (80–120 ml). All lesions had microscopically negative resection margins. Median follow-up was 13.5 months (range 12–15 months) with a disease-free survival rate of 100%. Conclusions Surgical robotic approach for large GISTs is feasibility and new evidences are needed to clarify the effective role of different surgical strategies.

Radical gastrectomy with an adequate lymphadenectomy is the main procedure which makes it possible to cure patients with resectable gastric cancer (GC). A number of randomized controlled trials and meta-analysis provide phase III evidence that laparoscopic gastrectomy is technically safe and that it yields better short-term outcomes than conventional open gastrectomy for early-stage GC. While laparoscopic gastrectomy has become standard therapy for early-stage GC, especially in Asian countries such as Japan and South Korea, the use of minimally invasive techniques is still controversial for the treatment of more advanced tumours, principally due to existing concerns about its oncological adequacy and capacity to carry out an adequately extended lymphadenectomy. Some intrinsic drawbacks of the conventional laparoscopic technique have prevented the worldwide spread of laparoscopic gastrectomy for cancer and, despite technological advances in recent year, it remains a technically challenging procedure. The introduction of robotic surgery over the last ten years has implied a notable mutation of certain minimally invasive procedures, making it possible to overcome some limitations of the traditional laparoscopic technique. Robot-assisted gastric resection with D2 lymph node dissection has been shown to be safe and feasible in prospective and retrospective studies. However, to date there are no high quality comparative studies investigating the advantages of a robotic approach to GC over traditional laparoscopic and open gastrectomy. On the basis of the literature review here presented, robot-assisted surgery seems to fulfill oncologic criteria for D2 dissection and has a comparable oncologic outcome to traditional laparoscopic and open procedure. Robot-assisted gastrectomy was associated with the trend toward a shorter hospital stay with a comparable morbidity of conventional laparoscopic and open gastrectomy, but randomized clinical trials and longer follow-ups are needed to evaluate the possible influence of robot gastrectomy on GC patient survival.

Purpose: Single-incision laparoscopic surgery (SILS) offers excellent cosmetic results and may be associated with decreased postoperative pain and accelerated recovery. Although there have been reports of cholecystectomy and appendectomy using SILS, there have been few reports of gastric resection with intracorporeal reconstruction of the digestive tract using SILS. The first single-incision laparoscopic gastrectomy with intracorporeal reconstruction is reported. Methods: Preliminary experience with single-incision laparoscopic gastrectomy with intracorporeal reconstruction for a patient with an intractable gastric ulcer is reported. Results: Single-incision laparoscopy-assisted subtotal gastrectomy and Roux-en-Y reconstruction were performed. Operative time for gastrectomy and paraduodenal hernioplasty was 412 minutes, and blood loss was 90 g. No intraoperative or postoperative complications developed. Conclusions: Single-incision laparoscopy-assisted gastrectomy for intractable gastric ulcer is technically feasible. Intracorporeal reconstruction of the digestive tract was performed safely using a linear endoscopic stapler. This surgical approach is a further advance toward scarless surgery of the stomach., Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, 22(4), pp.e210-e213; 2012

While the incidence of gastric cancer has declined substantially, it remains a major cause of morbidity and mortality. Surgical resection offers the best chance for curative treatment. Despite numerous studies, surgical controversies persist including endoscopic resection, extent of gastric resection, degree of lymphadenectomy, and laparoscopic resection. Balancing the benefits with the risks of surgical morbidity and mortality is essential. This review examines these controversies and provides insight into the surgical management of gastric cancer.

Background: Gastrectomy has been indicated as a risk factor for laryngeal cancer, and possibly also for pharyngeal cancer, but few studies are available. The postulated mechanism is increased bile reflux following gastrectomy. Methods: This was a population-based cohort study of patients who underwent gastrectomy for peptic ulcer disease between 1964 and 2008 in Sweden. Follow-up data for cancer was obtained from the Swedish Cancer Register. Relative risk was calculated as standardised incidence ratios (SIRs) with 95% confidence intervals (CIs). Results: The gastrectomy cohort comprises 19 767 patients, contributing 348 231 person-years at risk. The observed number of patients with laryngeal (n=56) and pharyngeal cancer (n=28) was two-fold higher than the expected (SIR: 2.0, 95% CI: 1.5–2.6 and SIR: 2.4, 95% CI: 1.6–3.5, respectively). After exclusion of 5536 cohort members with tobacco- or alcohol-related disease, the point SIRs remained increased (SIR: 1.6, 95% CI: 1.1–2.2 and SIR: 1.7, 95% CI: 0.9–2.8, respectively). The SIRs of laryngeal and pharyngeal cancer increased with time after gastrectomy (P for trend