Cargando…

Fluoroscopic balloon dilation for early jejunojejunostomy obstruction after gastrectomy with roux-en-Y reconstruction: a case series of three patients

BACKGROUND: Small bowel obstruction after gastrectomy with Roux-en-Y reconstruction (R-Y reconstruction) is not a rare complication. However, patients who need re-operation for this complication have a high rate of postoperative complications. We report a case series of three patients who underwent...

Descripción completa

Detalles Bibliográficos
Autores principales: Kamada, Teppei, Ohdaira, Hironori, Hoshimoto, Sojun, Narihiro, Satoshi, Suzuki, Norihiko, Marukuchi, Rui, Takeuchi, Hideyuki, Yoshida, Masashi, Yamanouchi, Eigoro, Suzuki, Yutaka
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246273/
https://www.ncbi.nlm.nih.gov/pubmed/32448939
http://dx.doi.org/10.1186/s40792-020-00871-4
_version_ 1783537908681015296
author Kamada, Teppei
Ohdaira, Hironori
Hoshimoto, Sojun
Narihiro, Satoshi
Suzuki, Norihiko
Marukuchi, Rui
Takeuchi, Hideyuki
Yoshida, Masashi
Yamanouchi, Eigoro
Suzuki, Yutaka
author_facet Kamada, Teppei
Ohdaira, Hironori
Hoshimoto, Sojun
Narihiro, Satoshi
Suzuki, Norihiko
Marukuchi, Rui
Takeuchi, Hideyuki
Yoshida, Masashi
Yamanouchi, Eigoro
Suzuki, Yutaka
author_sort Kamada, Teppei
collection PubMed
description BACKGROUND: Small bowel obstruction after gastrectomy with Roux-en-Y reconstruction (R-Y reconstruction) is not a rare complication. However, patients who need re-operation for this complication have a high rate of postoperative complications. We report a case series of three patients who underwent fluoroscopic balloon dilation (FBD) for early jejunojejunostomy obstruction (JJO) after gastrectomy with Roux-en-Y reconstruction (R-Y reconstruction). CASE PRESENTATION: Three patients were referred to our hospital for surgery for gastric cancer. Robot-assisted distal gastrectomy with D2 lymph node dissection and antecolic R-Y reconstruction were performed in two patients, and robot-assisted total gastrectomy with D1+ lymph node dissection and antecolic R-Y reconstruction was performed in one patient. The jejunojejunostomy was created as a side-to-side anastomosis using a linear 45-mm stapler. The entry hole was closed with a knotless barbed suture, and serosal-muscle layer suture reinforcement with an absorbable suture was performed at the jejunojejunostomy. Subsequently, all the patients were diagnosed with JJO by computed tomography and upper gastrointestinal series. The average time to JJO from gastrectomy was 5 days (range 2–7); initial clinical symptoms were vomiting in all three cases, with simultaneous upper abdominal pain in one case. We successfully performed FBD in all three cases after unsuccessful conservative treatment using an ileus tube. The clinical symptoms improved soon after FBD, and all the patients were able to avoid re-operation. The average period to FBD from JJO was 10 days (range 4–14). The average procedure time was 46 min (range 29–68), and the average duration to oral intake from FBD was 4 days (range 2–5). The average duration of hospital stay after FBD was 12 days (range 9–15). There were no complications in any of the cases. CONCLUSION: FBD might be a feasible procedure to avoid surgery for early small bowel obstruction after gastrectomy with R-Y reconstruction.
format Online
Article
Text
id pubmed-7246273
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Springer Berlin Heidelberg
record_format MEDLINE/PubMed
spelling pubmed-72462732020-06-03 Fluoroscopic balloon dilation for early jejunojejunostomy obstruction after gastrectomy with roux-en-Y reconstruction: a case series of three patients Kamada, Teppei Ohdaira, Hironori Hoshimoto, Sojun Narihiro, Satoshi Suzuki, Norihiko Marukuchi, Rui Takeuchi, Hideyuki Yoshida, Masashi Yamanouchi, Eigoro Suzuki, Yutaka Surg Case Rep Case Report BACKGROUND: Small bowel obstruction after gastrectomy with Roux-en-Y reconstruction (R-Y reconstruction) is not a rare complication. However, patients who need re-operation for this complication have a high rate of postoperative complications. We report a case series of three patients who underwent fluoroscopic balloon dilation (FBD) for early jejunojejunostomy obstruction (JJO) after gastrectomy with Roux-en-Y reconstruction (R-Y reconstruction). CASE PRESENTATION: Three patients were referred to our hospital for surgery for gastric cancer. Robot-assisted distal gastrectomy with D2 lymph node dissection and antecolic R-Y reconstruction were performed in two patients, and robot-assisted total gastrectomy with D1+ lymph node dissection and antecolic R-Y reconstruction was performed in one patient. The jejunojejunostomy was created as a side-to-side anastomosis using a linear 45-mm stapler. The entry hole was closed with a knotless barbed suture, and serosal-muscle layer suture reinforcement with an absorbable suture was performed at the jejunojejunostomy. Subsequently, all the patients were diagnosed with JJO by computed tomography and upper gastrointestinal series. The average time to JJO from gastrectomy was 5 days (range 2–7); initial clinical symptoms were vomiting in all three cases, with simultaneous upper abdominal pain in one case. We successfully performed FBD in all three cases after unsuccessful conservative treatment using an ileus tube. The clinical symptoms improved soon after FBD, and all the patients were able to avoid re-operation. The average period to FBD from JJO was 10 days (range 4–14). The average procedure time was 46 min (range 29–68), and the average duration to oral intake from FBD was 4 days (range 2–5). The average duration of hospital stay after FBD was 12 days (range 9–15). There were no complications in any of the cases. CONCLUSION: FBD might be a feasible procedure to avoid surgery for early small bowel obstruction after gastrectomy with R-Y reconstruction. Springer Berlin Heidelberg 2020-05-24 /pmc/articles/PMC7246273/ /pubmed/32448939 http://dx.doi.org/10.1186/s40792-020-00871-4 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Case Report
Kamada, Teppei
Ohdaira, Hironori
Hoshimoto, Sojun
Narihiro, Satoshi
Suzuki, Norihiko
Marukuchi, Rui
Takeuchi, Hideyuki
Yoshida, Masashi
Yamanouchi, Eigoro
Suzuki, Yutaka
Fluoroscopic balloon dilation for early jejunojejunostomy obstruction after gastrectomy with roux-en-Y reconstruction: a case series of three patients
title Fluoroscopic balloon dilation for early jejunojejunostomy obstruction after gastrectomy with roux-en-Y reconstruction: a case series of three patients
title_full Fluoroscopic balloon dilation for early jejunojejunostomy obstruction after gastrectomy with roux-en-Y reconstruction: a case series of three patients
title_fullStr Fluoroscopic balloon dilation for early jejunojejunostomy obstruction after gastrectomy with roux-en-Y reconstruction: a case series of three patients
title_full_unstemmed Fluoroscopic balloon dilation for early jejunojejunostomy obstruction after gastrectomy with roux-en-Y reconstruction: a case series of three patients
title_short Fluoroscopic balloon dilation for early jejunojejunostomy obstruction after gastrectomy with roux-en-Y reconstruction: a case series of three patients
title_sort fluoroscopic balloon dilation for early jejunojejunostomy obstruction after gastrectomy with roux-en-y reconstruction: a case series of three patients
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246273/
https://www.ncbi.nlm.nih.gov/pubmed/32448939
http://dx.doi.org/10.1186/s40792-020-00871-4
work_keys_str_mv AT kamadateppei fluoroscopicballoondilationforearlyjejunojejunostomyobstructionaftergastrectomywithrouxenyreconstructionacaseseriesofthreepatients
AT ohdairahironori fluoroscopicballoondilationforearlyjejunojejunostomyobstructionaftergastrectomywithrouxenyreconstructionacaseseriesofthreepatients
AT hoshimotosojun fluoroscopicballoondilationforearlyjejunojejunostomyobstructionaftergastrectomywithrouxenyreconstructionacaseseriesofthreepatients
AT narihirosatoshi fluoroscopicballoondilationforearlyjejunojejunostomyobstructionaftergastrectomywithrouxenyreconstructionacaseseriesofthreepatients
AT suzukinorihiko fluoroscopicballoondilationforearlyjejunojejunostomyobstructionaftergastrectomywithrouxenyreconstructionacaseseriesofthreepatients
AT marukuchirui fluoroscopicballoondilationforearlyjejunojejunostomyobstructionaftergastrectomywithrouxenyreconstructionacaseseriesofthreepatients
AT takeuchihideyuki fluoroscopicballoondilationforearlyjejunojejunostomyobstructionaftergastrectomywithrouxenyreconstructionacaseseriesofthreepatients
AT yoshidamasashi fluoroscopicballoondilationforearlyjejunojejunostomyobstructionaftergastrectomywithrouxenyreconstructionacaseseriesofthreepatients
AT yamanouchieigoro fluoroscopicballoondilationforearlyjejunojejunostomyobstructionaftergastrectomywithrouxenyreconstructionacaseseriesofthreepatients
AT suzukiyutaka fluoroscopicballoondilationforearlyjejunojejunostomyobstructionaftergastrectomywithrouxenyreconstructionacaseseriesofthreepatients