Hideo Takahashi, MD1, Matthew Allemang, MD1, Mena Boules, MD1, Zubaidah NorHanipah, MD1, Andrew Strong, MD1, Alfredo D Guerron, MD2, Kevin El-Hayek, MD, FACS1, John H Rodriguez, MD1, Matthew Kroh, MD, FACS1. 1Section of Surgical Endoscopy, Dept. of General Surgery, Cleveland Clinic, 2Duke University Health System
INTRODUCTION: Reoperative foregut surgery has high complication rates. Completion gastrectomy with resection of diseased organ may be necessary as a definitive procedure. Literature evaluating outcomes after completion gastrectomy with esophagojejunostomy (EJ) for benign diseases is limited. We present an experience of proximal gastrectomy requiring EJ in the setting of benign disease over the past 13 years at a single tertiary referral center.
METHODS AND PROCEDURES: All patients who underwent total, proximal, or completion gastrectomy with EJ for benign foregut surgery complications were retrospectively identified from January 2003 to December 2015. All cancer operations were excluded. There were 23 patients who underwent EJ either open or laparoscopically. Statistical analysis was performed using JMP 13 and p< 0.05 was considered statistically significant.
RESULTS: Thirteen patients underwent laparoscopic EJ and 10 had an open EJ. The index operations included 12 anti-reflux, 9 bariatric, and 2 peptic ulcer disease surgeries. Seventy-eight percent of patients had surgical or endoscopic interventions prior to EJ. Mean previous interventions (surgery and endoscopic) prior to EJ was 3± 0.8 times and median interval to EJ was 25 months (IQR 9-87). One laparoscopic EJ case was converted to open due to significant adhesions. Roux reconstruction was completed antecolic in 13 patients, and retrocolic in 9 patients, and one was unrecorded. Two patients developed post-operative marginal ulcers.
Comparison between them showed similar operating times, estimate blood loss, and complication rates. Laparoscopic EJ demonstrated significantly shorter length of stay (p<0.001), less postoperative ICU days (p= 0.002), and less readmissions (p=0.024). Postoperative nutrition therapy was required after all open EJ and only 50% of laparoscopic EJ. Majority of these were receiving enteral nutrition. The overall complication rate was 65% with 35% classified being severe (Clavien-Dindo>III) and no 90-day mortalities.
|LEJ (13)||OEJ (10)||P|
Operation Time (min)
2241.6 ± 22.8
279.6 ± 31.1
|Length of Stay (days)||
6.5 ± 1.6
|ICU stay (days)||0.1± 0.1||4.8± 1.4||0.002|
|Readmission||2 (15.4%)||6 (60%)||0.024|
CONCLUSIONS: Our series demonstrates that EJ is a reasonable option for reoperative foregut surgery. The laparoscopic approach appears to be associated with decreased length of stay and readmissions.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77656
Program Number: P398
Presentation Session: Poster (Non CME)
Presentation Type: Poster