全周性外翻三角吻合による消化管再建術の検討

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  • COMPLETELY EVERTED TRIANGULAR GASTROINTESTINE ANASTOMOSIS USING A LINEAR STAPLER

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Purpose: Reconstruction using anastomotic instruments in gastrointestinal surgery still has complications such as leakage and stenosis. Whether completely everted triangular anastomosis is effective in preventing the anastomotic complications was studied. Methods: By using isolated bovine large bowel, completely everted triangular anastomosis was compared with the ordinary triangular anastomosis which consisted of inverted suturing in the base of a triangle. From results of the preliminary experiment, clinical study for the all-everted triangular anastomosis was performed. Fifteen patients (surgery for esophagus: two, stomach: eight, colon: five cases) were reconstructed by all-everted triangular anastomosis (Group A). Group A was compared to Group B, which consisted of thirty patients with the ordinary triangular anastomosis. Results: In the experimental model, the staple line of completely everted triangular anastomosis was straight, while that of the ordinary one was not. The mean anastomotic caliber of the former was larger than that of the latter. Anastomotic leaks observed were 6.7% in both groups (2/30vs. 1/15), and anastomotic stenosis occurred in four patients in Group B (0vs. 13.3%). Conclusions: Completely everted triangular anastomosis is safe and seems to be associated with less chance of anastomotic stenosis.

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