Nghe An General Friendship Hospital develops endoscopic gastric surgery technique

Successful implementation of laparoscopic upper gastrectomy

Patient Phan Trong B. (born in 1952, in Nam Giang commune, Nam Dan district) has a history of chronic gastric ulcer. Recently, the patient has had epigastric pain, a dull pain that has increased day by day. This time, the patient had difficulty swallowing, had poor appetite, and lost weight, so he went to Nghe An General Hospital for examination.

Here, the patient was examined and performed the necessary paraclinical tests. Based on the results of endoscopy, biopsy... the doctors diagnosed the patient with stage IIA gastric cardia cancer (pT2R0N1), gastric ulcer, dysphagia - monitoring esophageal cancer, so he was transferred to the Department of Gastroenterology for treatment.

After consultation, the doctors decided to perform laparoscopic surgery to cut the upper pole of the stomach and connect it to the Double-tract with a Hemi-double anvil. After surgery, the patient recovered quickly, was able to move and eat from the second day after surgery and was discharged after 7 days of treatment.

Another case is patient Nguyen Van Ch. (born in 1958, in Hung Tien commune, Nam Dan district), who came to the hospital with abdominal pain. Through medical history, the patient had a history of gastritis, recently had epigastric pain, dull pain that increased, accompanied by poor appetite and weight loss. The patient went to the doctor and discovered a tumor under the esophagus mucosa, duodenal ulcer scar causing a lot of contraction. Patient Ch. requested to be transferred to Nghe An General Hospital for treatment.

After examination and necessary paraclinical tests, the doctors determined that patient Ch. had gastric cardia tumor, gastritis, GEERD and was indicated for laparoscopic surgery to resect the upper pole of the stomach and connect it to the Double-tract with a Hemi-double anvil. After surgery, patient Ch.'s health recovered well, he could move, on the second day after surgery, the patient was able to eat and drink and was discharged after 7 days of treatment.

Dr. Dinh Van Chien - Deputy Director of the Center for Training and Guidance, treating physician of the Department of Gastroenterology, Nghe An General Hospital, said: "Laparoscopic surgery to resect the upper pole of the stomach (resect the upper part of the stomach) is the most difficult and specialized technique among the techniques of gastrectomy, because in addition to the problem of stomach dissection and lymph node dissection, reestablishing digestive circulation after resecting the upper part of the stomach is a big challenge for surgeons to ensure the quality of life for patients after surgery, avoiding reflux of gastric juice into the esophagus. Previously, resection of the upper part of the stomach was mainly performed in open surgery and anastomosis was made in the traditional way (connecting the remaining stomach to the esophagus). With the traditional anastomosis, the advantage is that the surgery is quick, there are few anastomoses so there is less risk of anastomotic leakage, but the patient faces the risk of gastroesophageal reflux, the risk of anastomotic cancer...".

According to a study by Yu Wai Pu analyzing 2 randomized studies and 9 retrospective studies with 13,64 patients, it shows that postoperative gastroesophageal reflux accounts for a very high rate of 20% - 30%. Studies also show that gastroesophageal reflux is one of the causes that greatly affects the quality of life and daily activities of patients; especially it has the potential risk of causing cancer of the anastomosis and esophagus later.

Currently, with the development of science and technology, medical equipment, supplies... as well as the increasingly high level of scientific expertise of the team of surgeons, Nghe An General Hospital has approached the development of medical science in the world, so it has successfully implemented many difficult and specialized techniques such as digestive anastomosis techniques using the Double-tract, Double-flap, Interposition jejunal methods... with the OrVil, Anvil, Hemi-double Anvil anastomoses, which have helped improve the quality of life for patients after upper gastrectomy, reducing the incidence of postoperative gastroesophageal reflux.

After successfully performing two laparoscopic surgeries to resect the upper pole of the stomach and connect it to the circulation via the Double-tract using the Hemi-double anvil, the hospital will routinely apply this technique to treat patients with stomach cancer, thereby helping patients reduce treatment costs, as well as contributing to reducing the burden on the upper level.

Pioneer in endoscopic surgery for cancer treatment

According to Associate Professor, Dr. Nguyen Van Huong - Director of Nghe An General Hospital, said: "In recent years, implementing Resolution 26 - NQ/TW dated July 30, 2013 of the Politburo, Nghe An General Hospital has always focused on investing in the development of synchronous, multi-disciplinary, multi-field specialized techniques and applying advanced techniques in the world to medical examination and treatment, achieving outstanding achievements. In particular, laparoscopic surgery to remove D2 lymph nodes to treat stomach cancer is one of the remarkable achievements.

Following the success of Resolution 26 - NQ/TW and implementing Action Program No. 68-CTr/TU dated November 15, 2023 of Nghe An Provincial Party Committee to implement Resolution 39-NQ/TW of the Politburo, Nghe An General Hospital is continuing to deploy and develop special specialized techniques to build Vinh city into a specialized medical center in the North Central region, meeting the needs of medical examination and treatment for people in Nghe An province, the North Central region and Laos.

After more than a decade of Nghe An General Hospital implementing laparoscopic gastrectomy and lymph node dissection surgery, up to now, 779 stomach cancer patients have benefited from advanced, specialized techniques right in their homeland, thereby improving their health, quality of life and life expectancy.

Among 779 gastric cancer patients indicated for surgery, there were 560 cases of laparoscopic lower hemigastrectomy with D2 lymphadenectomy, 56 cases of laparoscopic lower hemigastrectomy with D2 lymphadenectomy to create Delta-shaped anastomosis, 152 cases of laparoscopic total gastrectomy with D2 lymphadenectomy to create T-shaped functional end-to-end anastomosis, 09 cases of laparoscopic upper pole gastrectomy, 02 cases of laparoscopic transgastric surgery to remove submucosal tumors in the cardiac region, the first in Vietnam.

Dr. Dinh Van Chien added: The successful implementation of advanced, specialized techniques and the application of advanced techniques in the world in the treatment of stomach cancer at the hospital in recent years not only brings benefits to patients such as early recovery, improving the quality of life, labor and longevity of patients but also contributes to promoting scientific research and specialized training for medical staff at the hospital and in the region.

Particularly, the T-shaped functional end-to-end anastomosis technique in laparoscopic total gastrectomy (researched and successfully applied in treatment by Associate Professor, Dr. Nguyen Van Huong and Dr. Dinh Van Chien) reported at the National Scientific Conference on Surgery and Endoscopic Surgery, the Asia-Pacific Gastric Cancer Conference was evaluated by leading experts and scientists at home and abroad as highly scientific and of practical significance in treatment. This technique has been invited to give scientific reports at specialized scientific conferences in the field of gastric cancer treatment with leading experts from Japan and Korea held at K Hospital, 108 Hospital, University of Medicine and Pharmacy Hospital in Ho Chi Minh City, Viet Tiep Hospital in Hai Phong, Hue Central Hospital...

In the coming time, Nghe An General Hospital will continue to develop and deploy more advanced, specialized techniques to contribute to improving people's health./.