Iwao Kitazono, MD, PhD1, Jun Kadono, MD1, Shunsuke Motoi, MD1, Masashi Ookawa, MD1, Fumisato Sasaki, MD, PhD2, Yuichiro Nasu, MD, PhD2, Akio Ido, MD, PhD2, Yutaka Imoto, MD, PhD1. 1Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 2Digestive and Lifestyle Disease, Kagoshima University Graduate School of Medical and Dental Scinece
Background: Technique of endoscopic submucosal dissection (ESD) for duodenal tumors has been advancing, but complications such as delayed perforation and bleeding are yet to be solved. It still remains a matter of debate if the suppression of pancreatic juice activation by draining bile juice actually prevents these complications.
Objective: To evaluate the role of bile drainage by transcystic tube (C-tube) for preventing postoperative perforation and bleeding after laparoscopic-endoscopic cooperative surgery (LECS) for duodenal tumors.
Patients and Methods: Two distinct surgical procedures: ESD reinforced by sero-muscular suture (ESD method) and whole layer resection (Resection method) were advocated. For tumor located in the duodenum adhering to the pancreas or in cases when the carcinoma was diagnosed preoperatively, ESD preceded by sero-muscular suture was performed, and for the tumor diagnosed as adenoma and localized to the free wall, whole layer resection was performed endoscopically or laparoscopically and was followed by Albert-Lembert suture. Laparoscopic cholecystectomy and C-tube placement were performed after tumor resection. ESD was performed in 2 patients with carcinoma diagnosed preoperatively (46, 32mm). Resection method was carried out in 2 patients with adenoma (16, 19 mm). Operation time were 409 and 276 minutes in ESD group, and 320 and 374 minutes in Resection group. Blood loss was minimal in all cases.Results: None of the patients had postoperative complications. C-tube was removed on seventh postoperative day. Compared to patients treated with ESD alone, in previous 26 cases, those treated with LECS had evidently no postoperative blood loss (3.8 % Vs 0 %) or delayed perforation (7.7 % Vs 0 %).
Conclusions: LECS with C-tube placement as a minimal invasive procedure is useful and effective in preventing postoperative complications after LECS for duodenal tumors.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77395
Program Number: P599
Presentation Session: Poster (Non CME)
Presentation Type: Poster
