Authors
Fedorov V.E.1, Barsukov V.Yu.1, Podelyakin K.A.1, Masljakov V.V.2
1 Saratov State Medical University named after V.I. Razumovsky, Saratov
2 Mari State University, Joshkar-Ola
Abstract
Purpose. Improving the quality and timeliness of diagnosis of leakage of the esophagojejunal anastomosis after gastrectomy.
Methods and materials are presented by the description of a case of examination and treatment of patient K., 58 years old, with a malignant neoplasm of the stomach. The active manifestation of the disease began with profuse gastric bleeding, which led to an emergency operation. Surprisingly, an anaplastic gastric cancer was discovered when examining a postoperative preparation. After discharge with a control fibrogastroscopy performed on an outpatient basis, a biopsy of the scar in the stomach re-verified the diagnosis. In this regard, the patient was admitted for surgical treatment in a planned manner. It consisted of gastrectomy with jejunoplasty, pancreatic tail resection and D2 lymphadenectomy.
Results. In the postoperative period, the patient developed a subphrenic abscess on the left, the cause of which was the failure of the esophageal-small intestinal junction, which proceeded with an atypical clinical picture. Risk factors for complications after gastrectomy were identified: a high degree of malignancy of the tumor process, asthenization and anemia after emergency surgery for profuse gastric bleeding. With multiple fibrogastroscopy in this patient, it was found that the key role in the development of leak of esophagojejunostomy was played by the staple bracket used when applying circular esophagojejunostomy.
Conclusion. With a combination of multiple risk factors for postoperative complications after gastrectomy, it is possible to develop leakage of esophagojejunal anastomosis with an unusual cause and an atypical course.
Keywords: gastric cancer, gastrectomy, circular stapling apparatus, postoperative complications, anastomotic leakage.
References
1. Kotan C, Kisli E, Sönmez R, et al. Noncurative total gastrectomy and oesophagogastrectomy in the treatment of advanced gastric carcinoma in a country with high incidence. Acta Chir Belg. 2005; 105(5): 519-522. doi: 10.1080/00015458.2005.11679772.
2. Mulholland MW, Doherty GM. Complications in Surgery. Lippincott Williams Wilkins. Philadelphia; Baltimore; N.Y.; L., 200: 396–473.
3. Yang YS, Chen LQ, Yan XX, et al. Preservation versus non-preservation of the duodenal passage following total gastrectomy: a systematic review. J. Gastrointest Surg. 2013; 17(5): 877–886.
4. Volkov VE, Volkov SV, Igonin JuA, et al. Diagnosis and treatment of purulent-septic complications in patients undergoing gastrectomy. Vestnik Chuvashskogo universiteta. 2014; 2: 199-205 (In Russ).
5. Andreollo NA, Lopes LR, Coelho Neto S Postoperative complications after total gastrectomy in the gastric cancer. Analis of 300 patients. ABCD Arq Brus. Chir. Dig. 2011; 24(2): 126-130.
6. Davydov MI, Ter-Avanesov MD Modern strategy for surgical treatment of stomach cancer. Sovremennaja onkologija. 2000; 2(1): 4-10. (In Russ).
7. Davydov MI, Turkin IN, Polockij BE Modern gastric cancer surgery: from D2 to D3. IX Rossijskij onkologicheskij kongress: materialy kongressa. 2005: 41-43 (In Russ).
8. Ruchkin DV, Jan C Eunogastroplasty as an alternative way to reconstruct the digestive tract after gastrectomy. Hirurgija. Zhurnal im. N.I. Pirogova. 2015; 9: 57-62 (In Russ).
9. Oka S, Sakuramoto S, Chuman M, et al. Successful treatment of refractory complete separation of an esophagojejunal anastomosis after laparoscopic total gastrectomy: a case report. BMC Res. Notes. 2017; 10(1): 267. doi: 10.1186/s13104-017-2589-6.
10. Dumanskij JuV, Stepko VA, Sinjachenko OV Risk factors for early postoperative lethal complications in patients with gastroesophageal cancer. Клінічна хірургія. 2016; 2: 5-7 (In Ukraine).
11. Gong W, Li J. Combat with esophagojejunal anastomotic leakage after total gastrectomy for gastric cancer: A critical review of the literature. Int. J Surg. 2017; 47: 18-24. doi: 10.1016/j.ijsu.2017.09.019.
12. Robak AN, Ruchkin VI, Korzh SS, Osmonaliev BK Formation of compression circular esophageal anastomoses in gastric cancer. Rossijskij medicinskij zhurnal. 2008; 2: 19-21. (In Russ).
13. Ruchkin VI, Robak AN, Myslivcev SV et al. Comparative characteristics of manual ligature and compression nickelidtitan esophageal-intestinal anastomoses in gastrectomy. Hirurgija. Zhurnal im. N.I. Pirogova. 2012; 7: 64-69 (In Russ).
14. Ahmetzjanov FSh, Borisov VP, Ahmetzjanova FF, et al. Original method of esophagoeunoanoanastomosis for gastric cancer gastrectomy in the prevention of postoperative complications Kazanskij medicinskij zhurnal. 2014; 95(4): 505-510 (In Russ). doi: 10.17816/KMJ1831.
15. Ladur AI, Zaika AN, Barguti A, et al. Causes of failure of anastomosis sutures after gastrectomy. Novoobrazovanie. 2018; 10(1): 4-7. (In Russ). doi: 10.26435/neoplasm.v10i1.234.
16. Moreno AH. Studies on Nutritional and Other Disturbances Following Operations for Cancer of the Stomach: With Particular Reference to the Use of a Jejunal Pouch as a Substitute Gastric Reservoir. Annals of surgery. 1956; 144(5): 779.
17. Hunt CJ Construction of food pouch from segment of jejunum as substitute for stomach in total gastrectomy. Archives of Surgery. 1952; 64 (5): 601. Doi: 10.1001/archsurg.1952.01260010619009.
18. Jangjoo A, Mehrabi Bahar M, Aliakbarian M. Uncut Roux-en-y esophagojejunostomy: A new reconstruction technique after total gastrectomy. Indian. J Surg. 2010; 72(3): 236-239. doi:10.1007/s12262-010-0059-7.
19. Volkov SV. Failure of esophageal-intestinal anastomosis in patients after typical and combined gastrectomy: clinical and surgical aspects. Vestnik Chuvashskogo universiteta. 2010; 3: 80-88. (In Russ).
20. Besova NS, Trjakin AA, Artamonova EV, et al. Practical Guidelines for the Drug Treatment of Stomach Cancer. Zlokachestvennye opuholi: Prakticheskie rekomendacii RUSSCO. 2020; 10(3s2): 339-354. (In Russ). doi: 10.18027 / 2224-5057-2020-10-3s2-21.
