The efficacy and safety of a new hand-sewn intestinal anastomosis method in the Roux-en-Y anastomosis of gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Qiang , YAO Libin , LI Chao , WANG Hui , MENG Song , HONG Jian , SHAO Yong ,  ZHU Xiaocheng

徐州医科大学附属医院胃肠外科（江苏徐州 221000）;

Corresponding author：

ZHU Xiaocheng, Email: zxhhl35@126.com

Keywords：

hand-sewn intestinal anastomosis; stapled anastomosis; Roux-en-Y anastomosis; gastric cancer; effect

DOI：

10.7507/1007-9424.201710042

Video：

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Objective To compare the effectiveness between a new hand-sewn intestinal anastomosis and stapled anastomosis during Roux-en-Y anastomosis of gastric cancer. Methods Retrospectively, we collected 200 gastric cancer patients who underwent radical distal or total gastrectomy from January 2014 to June 2017 in our hospital, and divided them into observation group (new hand-sewn anastomosis, n=100) and control group (stapled anastomosis, n=100) according to the type of anastomosis. The time and cost taken to perform the anastomosis, the incidence of postoperative complications (including anastomotic leakage, bleeding, and stenosis), and hospital stay were compared. Results The cost of anastomosis in the observation group was significantly lower than that of the control group [(194.1±13.5) RMB vs (5 270.3±852.7) RMB, P<0.001], and the time taken to perform was just slightly longer in the observation group [(8.34 ± 0.65) minvs (8.29±0.61 ) min, P=0.540], additionally the incidences between the observation group and the control group, in regards to anastomotic bleeding [0 (0/100) vs 3% (3/100), P=0.246], leakage [0 (0/100) vs 1% (1/100), P=1.000], stenosis [0 (0/100) vs 2% (2/100), P=0.497], and hospital stay [(18.8±7.4) d vs (19.2±6.2) d, P=0.175], showed no significant difference between the 2 groups. Conclusion The new hand-sewn anastomosis technology is safe and effective, easy to learn, and it can save money and time, which is worth promoting.

Citation： ZHANG Qiang, YAO Libin, LI Chao, WANG Hui, MENG Song, HONG Jian, SHAO Yong, ZHU Xiaocheng. The efficacy and safety of a new hand-sewn intestinal anastomosis method in the Roux-en-Y anastomosis of gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(5): 547-552. doi: 10.7507/1007-9424.201710042 Copy

1.	Garude K, Tandel C, Rao S, et al. Single layered intestinal anastomosis: a safe and economic technique. Indian J Surg, 2013, 75(4): 290-293.
2.	Chen C. The art of bowel anastomosis. Scand J Surg, 2012, 101(4): 238-240.
3.	Shikata S, Yamagishi H, Taji Y, et al. Single- versus two- layer intestinal anastomosis: a meta-analysis of randomized controlled trials. BMC Surg, 2006, 6: 2.
4.	Liu L, Li N, Lei T, et al. The in vitro biological properties of Mg-Zn-Sr alloy and superiority for preparation of biodegradable intestinal anastomosis rings. Med Sci Monit, 2014, 20: 1056-1066.
5.	Naumann DN, Bhangu A, Kelly M, et al. Stapled versus handsewn intestinal anastomosis in emergency laparotomy: a systemic review and meta-analysis. Surgery, 2015, 157(4): 609-618.
6.	Moran BJ. Stapling instruments for intestinal anastomosis in colorectal surgery. Br J Surg, 1996, 83(7): 902-909.
7.	Neutzling CB, Lustosa SA, Proenca IM, et al. Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev, 2012, (2): CD003144.
8.	Antoine Lembert 1802-1851. Study on intestinal suture with a description of a new procedure for performing this surgical operation. 1826. Dis Colon Rectum, 1988, 31(6): 489-494.
9.	Travers B. An enquiry into the process of nature in repairing injuries of the intestine. London: Longman, 1812: 25-36.
10.	Hautefeuille P. Gastrointestinal suturing. Apropos of 570 sutures performed over a 5-year period using a single layer continuous technic. Chirurgie, 1976, 102(2): 153-165.
11.	Tuchmann A, Dinstl K, Strasser K, et al. Stapling devices in gastrointestinal surgery. Int Surg, 1985, 70(1): 23-27.
12.	Fayek IS. Evaluation of stapled versus hand-sewn techniques for colo- rectal anastomosis after low anterior resection of mid-rectal carcinoma: a study on 50 patients. Asian Pac J Cancer Prev, 2014, 15(13): 5427-5431.
13.	刘忠理, 王飞, 赵路红. 新生儿肠切除肠吻合术临床分析. 中国实用医刊, 2016, 43(22): 116-118.
14.	黄从云, 彭淑牖. 肠道吻合愈合研究进展. 国外医学(外科学分册), 2005, 32(2): 114-119.
15.	黄从云, 张小龙, 朱剑华, 等. 小肠浆肌层吻合与二层吻合的临床随机对照研究. 中国普外基础与临床杂志, 2009, 16(5): 397-399.
16.	García-Osogobio SM, Takahashi-Monroy T, Velasco L, et al. Single-layer colonic anastomoses using polyglyconate (Maxon) vs. two-layer anastomoses using chromic catgut and silk. Experimental study. Rev Invest Clin, 2006, 58(3): 198-203.
17.	Enker WE, Merchant N, Cohen AM, et al. Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg, 1999, 230(4): 544-552.
18.	Matthiessen P, Hallböök O, Andersson M, et al. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis, 2004, 6(6): 462-469.
19.	Matthiessen P, Hallböök O, Rutegård J, et al. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg, 2007, 246(2): 207-214.
20.	童宜欣, 胡俊波, 杨传永, 等. 胃肠机械吻合与传统吻合术后并发症的比较(附 932 例报告). 中国普外基础与临床杂志, 2005, 12(1): 38-39.
21.	Griffen FD, Knight CD Sr, Whitaker JM, et al. The double stapling technique for low anterior resection. Results, modifications, and observations. Ann Surg, 1990, 211(6): 745-751.
22.	Kissin MW, Cox AG, Wilkins RA, et al. The fate of the EEA stapled anastomosis: a clinico-radiological study of 38 patients. Ann R Coll Surg Engl, 1985, 67(1): 20-22.
23.	Leff EI, Hoexter B, Labow SB, et al. The EEA stapler in low colorectal anastomoses: initial experience. Dis Colon Rectum, 1982, 25(7): 704-707.
24.	Wong J, Cheung H, Lui R, et al. Esophagogastric anastomosis performed with a stapler: the occurrence of leakage and stricture. Surgery, 1987, 101(4): 408-415.
25.	Hemming K, Pinkney T, Futaba K, et al. A systematic review of systematic reviews and panoramic meta-analysis: staples versus sutures for surgical procedures. PLoS One, 2013, 8(10): e75132.
26.	McLeod RS, Wolff BG, Ross S, et al. Recurrence of Crohn’s disease after ileocolic resection is not affected by anastomotic type: results of a multicenter, randomized, controlled trial. Dis Colon Rectum, 2009, 52(5): 919-927.

1. Garude K, Tandel C, Rao S, et al. Single layered intestinal anastomosis: a safe and economic technique. Indian J Surg, 2013, 75(4): 290-293.
2. Chen C. The art of bowel anastomosis. Scand J Surg, 2012, 101(4): 238-240.
3. Shikata S, Yamagishi H, Taji Y, et al. Single- versus two- layer intestinal anastomosis: a meta-analysis of randomized controlled trials. BMC Surg, 2006, 6: 2.
4. Liu L, Li N, Lei T, et al. The in vitro biological properties of Mg-Zn-Sr alloy and superiority for preparation of biodegradable intestinal anastomosis rings. Med Sci Monit, 2014, 20: 1056-1066.
5. Naumann DN, Bhangu A, Kelly M, et al. Stapled versus handsewn intestinal anastomosis in emergency laparotomy: a systemic review and meta-analysis. Surgery, 2015, 157(4): 609-618.
6. Moran BJ. Stapling instruments for intestinal anastomosis in colorectal surgery. Br J Surg, 1996, 83(7): 902-909.
7. Neutzling CB, Lustosa SA, Proenca IM, et al. Stapled versus handsewn methods for colorectal anastomosis surgery. Cochrane Database Syst Rev, 2012, (2): CD003144.
8. Antoine Lembert 1802-1851. Study on intestinal suture with a description of a new procedure for performing this surgical operation. 1826. Dis Colon Rectum, 1988, 31(6): 489-494.
9. Travers B. An enquiry into the process of nature in repairing injuries of the intestine. London: Longman, 1812: 25-36.
10. Hautefeuille P. Gastrointestinal suturing. Apropos of 570 sutures performed over a 5-year period using a single layer continuous technic. Chirurgie, 1976, 102(2): 153-165.
11. Tuchmann A, Dinstl K, Strasser K, et al. Stapling devices in gastrointestinal surgery. Int Surg, 1985, 70(1): 23-27.
12. Fayek IS. Evaluation of stapled versus hand-sewn techniques for colo- rectal anastomosis after low anterior resection of mid-rectal carcinoma: a study on 50 patients. Asian Pac J Cancer Prev, 2014, 15(13): 5427-5431.
13. 刘忠理, 王飞, 赵路红. 新生儿肠切除肠吻合术临床分析. 中国实用医刊, 2016, 43(22): 116-118.
14. 黄从云, 彭淑牖. 肠道吻合愈合研究进展. 国外医学(外科学分册), 2005, 32(2): 114-119.
15. 黄从云, 张小龙, 朱剑华, 等. 小肠浆肌层吻合与二层吻合的临床随机对照研究. 中国普外基础与临床杂志, 2009, 16(5): 397-399.
16. García-Osogobio SM, Takahashi-Monroy T, Velasco L, et al. Single-layer colonic anastomoses using polyglyconate (Maxon) vs. two-layer anastomoses using chromic catgut and silk. Experimental study. Rev Invest Clin, 2006, 58(3): 198-203.
17. Enker WE, Merchant N, Cohen AM, et al. Safety and efficacy of low anterior resection for rectal cancer: 681 consecutive cases from a specialty service. Ann Surg, 1999, 230(4): 544-552.
18. Matthiessen P, Hallböök O, Andersson M, et al. Risk factors for anastomotic leakage after anterior resection of the rectum. Colorectal Dis, 2004, 6(6): 462-469.
19. Matthiessen P, Hallböök O, Rutegård J, et al. Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg, 2007, 246(2): 207-214.
20. 童宜欣, 胡俊波, 杨传永, 等. 胃肠机械吻合与传统吻合术后并发症的比较(附 932 例报告). 中国普外基础与临床杂志, 2005, 12(1): 38-39.
21. Griffen FD, Knight CD Sr, Whitaker JM, et al. The double stapling technique for low anterior resection. Results, modifications, and observations. Ann Surg, 1990, 211(6): 745-751.
22. Kissin MW, Cox AG, Wilkins RA, et al. The fate of the EEA stapled anastomosis: a clinico-radiological study of 38 patients. Ann R Coll Surg Engl, 1985, 67(1): 20-22.
23. Leff EI, Hoexter B, Labow SB, et al. The EEA stapler in low colorectal anastomoses: initial experience. Dis Colon Rectum, 1982, 25(7): 704-707.
24. Wong J, Cheung H, Lui R, et al. Esophagogastric anastomosis performed with a stapler: the occurrence of leakage and stricture. Surgery, 1987, 101(4): 408-415.
25. Hemming K, Pinkney T, Futaba K, et al. A systematic review of systematic reviews and panoramic meta-analysis: staples versus sutures for surgical procedures. PLoS One, 2013, 8(10): e75132.
26. McLeod RS, Wolff BG, Ross S, et al. Recurrence of Crohn’s disease after ileocolic resection is not affected by anastomotic type: results of a multicenter, randomized, controlled trial. Dis Colon Rectum, 2009, 52(5): 919-927.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The efficacy and safety of a new hand-sewn intestinal anastomosis method in the Roux-en-Y anastomosis of gastric cancer

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